# Protruding Aortic Arch Thrombus in Cancer-Associated Stroke: Caution Regarding Endovascular Access

## TL;DR

A cancer patient with stroke had a dangerous blood clot in the aortic arch, showing the need for careful imaging before endovascular treatment.

## Contribution

Highlights the risk of endovascular therapy in cancer-associated stroke when aortic arch thrombi are present.

## Key findings

- A protruding aortic arch thrombus was found in a cancer patient during the thrombectomy window.
- Endovascular therapy was avoided due to high embolization risk from the aortic thrombus.
- Comprehensive vascular imaging is crucial to guide treatment and prevent complications.

## Abstract

In cancer-associated stroke, thrombi can be present beyond the cerebral vasculature. We report a case in which a protruding thrombus in the aortic arch was identified during the thrombectomy time window.

A 65-year-old woman with stage IIIC2 endometrial cancer presented with aphasia and right hemiparesis. Magnetic resonance imaging showed acute cerebral infarction in the left temporal lobe with M2 occlusion. Contrast-enhanced imaging revealed multiple thrombi, including a protruding thrombus in the aortic arch as well as others in the celiac artery, pulmonary artery, and femoral veins. Although the patient was eligible for endovascular therapy, the procedure was deferred owing to high risk of further embolization.

Endovascular therapy is a potential option in cancer-associated stroke but requires caution when aortic arch thrombi are present owing to increased embolic risk.

Comprehensive vascular imaging is essential in cancer-associated stroke to guide treatment and avoid procedural complications.