1074-160 - ASCENDING AORTIC THROMBUS: A CASE REPORT OF CATASTROPHIC SYSTEMIC EMBOLIZATION AND MANAGEMENT CHALLENGES

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Author Block: Enad Haddad, Sudeep Nugooru, Muhammad Sabri, Shayan Khan, Zaineb Alhassani, Jefferson Abington Hospital, Abington, PA, USA
Background: Ascending aortic thrombus (AAT) is a rare condition that can result in life-threatening arterial embolization. Multiple risk factors have been implicated in its incidence, and management has varied in terms of medical versus surgical approaches.
Case: 53-year-old female with a history of interstitial lung disease, hypertension, and cocaine use presented with right-sided weakness. CTA of the head and neck revealed occlusion of the left M1 segment of the middle cerebral artery along with incidental 1.8 cm intraluminal thrombus in the ascending aorta. She underwent M1 thrombectomy and was intubated for respiratory distress. For AAT, she was treated with heparin drip, and surgical management was deferred at the time. She developed renal emboli, mesenteric infarction, and multisystem organ failure. She was eventually transitioned to comfort care and expired.
Decision‐making: The patient's high surgical risk necessitated a more conservative approach with anticoagulation initially, particularly when repeat imaging 1 week later revealed decreased thrombus size. The plan was to evaluate for surgery after the patient's medical conditions stabilized. While anticoagulation alone has previously been shown to result in clot dissolution, the patient developed systemic emboli which were fatal.
Conclusion: AAT presents a significant treatment dilemma. Our case demonstrates the high embolization risk and highlights the need for thorough risk-benefit evaluation for surgical management of AAT.