Recently cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) and thrombosis following the adenoviral vector vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported. A mechanism similar to heparin-induced thrombocytopenia was proposed with antibodies to platelet factor 4 (PF4). Vaccine related arterial thrombosis in the brain is rare but life-threatening and optimal treatment is not established. We report clinical, laboratory, imaging findings and treatment in a 51-year-old female presenting with acute left middle cerebral artery (MCA) occlusion 7 days after the first dose of ChAdOx1 nCoV-19 vaccine. Due to low platelet count and suspicion of VITT she was not eligible for intravenous thrombolysis (IVT) and proceeded to mechanical thrombectomy (MER) with successful recanalization four hours after onset of symptoms. Treatment with intravenous immunoglobulin (IVIG) and heparin pentasaccharide fondaparinux was initiated. Presence of anti-PF4 antibodies was confirmed. The patient improved clinically with normalization of platelet count. Clinicians should be alert of VITT in patients with acute ischemic stroke after ChAdOx1 nCov-19 vaccination and low platelet counts. MER showed to be feasible and effective. We propose considering MER in patients with VITT and large vessel occlusion despite thrombocytopenia. High-dose IVIG should be started immediately. Alternative anticoagulation to heparin should be started 24 hours after stroke onset unless significant hemorrhagic transformation occurred. Platelet transfusion is contraindicated and should be considered only in severe hemorrhagic complications. Restenosis or reocclusion of the revascularized artery is possible due to the hypercoagulable state in VITT and angiographic surveillance after the procedure is reasonable.

最近报道了接种针对严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 的腺病毒载体疫苗后疫苗诱导的免疫性血栓性血小板减少症 (VITT) 和血栓形成的病例。血小板因子 4 (PF4) 抗体提出了一种类似于肝素诱导的血小板减少症的机制。大脑中与疫苗相关的动脉血栓形成很少见，但会危及生命，并且尚未确定最佳治疗方法。我们报告了一名 51 岁女性在首次接种 ChAdOx1 nCoV-19 疫苗后 7 天出现急性左侧大脑中动脉 (MCA) 闭塞的临床、实验室、影像学发现和治疗。由于血小板计数低和怀疑 VITT，她不符合静脉溶栓 (IVT) 的条件，并在症状出现 4 小时后进行了机械血栓切除术 (MER) 并成功再通。开始使用静脉内免疫球蛋白 (IVIG) 和肝素五糖磺达肝素进行治疗。确认存在抗PF4抗体。患者临床症状改善，血小板计数正常化。对于接种 ChAdOx1 nCov-19 疫苗后血小板计数低的急性缺血性卒中患者，临床医生应警惕 VITT。MER 被证明是可行和有效的。我们建议在 VITT 和大血管闭塞的患者中考虑 MER，尽管有血小板减少症。应立即开始大剂量 IVIG。除非发生明显的出血转化，否则应在卒中发作后 24 小时开始肝素替代抗凝治疗。血小板输注是禁忌的，仅应在严重的出血并发症中考虑。由于 VITT 中的高凝状态和手术后的血管造影监测是合理的，因此血管化动脉的再狭窄或再闭塞是可能的。