Bilateral Common Carotid Artery Thrombi Following Cisplatin-Based Chemotherapy (P1.027)

OBJECTIVE: To report a unique case of bilateral carotid thrombi following Cisplatin-based chemotherapy. BACKGROUND: Cisplatin-based chemotherapy has been implicated in venous and arterial thromboembolic events. These events typically occur with the second or third cycles of chemotherapy. Arterial thrombi involving the aortic arch secondary to Cisplatin-based chemotherapy have been reported to occur very rarely. Occurrence of bilateral carotid artery thrombi after Cisplatin-based chemotherapy has not, to our knowledge, been described. CASE DESCRIPTION: A 54 year-old man with a recent diagnosis of testicular cancer on chemotherapy with Cisplatin and Etoposide presented with severe headache and nausea. Physical exam was notable for left upper extremity weakness and left homonymous hemianopia. A CT scan of the head without contrast showed no abnormality. An MRI of the brain showed multiple acute and subacute infarcts involving both cerebral hemispheres. A CT angiogram of the head and neck revealed large thrombi causing near complete occlusion of the bilateral common carotid arteries. No thrombus was seen in the aortic arch. There was no evidence of venous sinus thrombosis. The patient was treated with parenteral anticoagulation. A week later, the left-sided weakness improved but the patient continued to have left homonymous hemianopia. A repeat CT angiogram of the head and neck revealed partial resolution of the thrombus. DISCUSSION AND CONCLUSION: Bilateral carotid thrombi after Cisplatin-based chemotherapy has never been reported before and physicians should be aware of this possibility. The mechanism of such events is thought to be related to vascular toxicity, endothelial damage, vasospasm and release of prothrombotic particles causing platelet aggregation and activation of coagulation cascade. Early diagnosis and treatment are important for good clinical outcome. Disclosure: Dr. Kaddouh has nothing to disclose. Dr. Tunguturi has nothing to disclose. Dr. Patel has nothing to disclose. Dr. DeGrush has nothing to disclose. Dr. Mandelbaum has nothing to disclose. Dr. Eleftheriou has nothing to disclose. Dr. Goddeau has nothing to disclose.