Keywords
Mechanical Thrombectomy
Large Vessel Occlusion
Ischemic Stroke
Hemorrhagic Shock
Categories
How to Cite
Abstract
Mechanical thrombectomy is an established treatment for acute ischemic stroke due to large‑vessel occlusion, and transfemoral access is generally safe. However, access‑site complications, though uncommon, can be severe. We report a fatal femoral access‑site pseudoaneurysm occurring after multimodal endovascular stroke reperfusion therapy.
A 69‑year‑old woman presented with acute left hemiparesis and was found to have a right M2 occlusion. She received intravenous tenecteplase followed by emergent mechanical thrombectomy via right femoral access, with complete reperfusion achieved. The procedure also required carotid angioplasty, closure‑device deployment, and periprocedural eptifibatide. Within hours, she developed an enlarging groin hematoma and early livedo reticularis of the thigh. Duplex ultrasound revealed a large femoral pseudoaneurysm, later localized angiographically to the profunda femoris–superficial femoral artery bifurcation. Despite urgent endovascular exclusion with a covered stent graft, she arrived in hemorrhagic shock and progressed to profound metabolic acidosis, multiorgan failure, and death from hypovolemic shock.
This case highlights how the combination of complex aortoiliac anatomy, large‑bore transfemoral access, closure‑device use, and potent antithrombotic exposure can predispose to rapid pseudoaneurysm expansion and severe hemorrhage. The early appearance of livedo reticularis represents a potentially important cutaneous warning sign of evolving vascular injury. Although limited to a single case, these observations underscore the need for careful access planning in anatomically challenging patients and prompt evaluation of early groin changes or unexplained clinical decline following endovascular stroke therapy.
References
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Copyright (c) 2026 Salar Shahzad, Zubair Ahmed, Falak Naz, Anusionwu Ikenna De Jason, Tehseen Zahra, Shaista Ali, Abdul Rauf, Jay Nfonoyim