Unmasking Dual Vascular Complications of Sunitinib in Advanced Renal Cell Carcinoma

Tyrosine kinase inhibitors (TKIs) such as sunitinib have transformed the management of advanced renal cell carcinoma (RCC), yet their association with thromboembolic complications remains incompletely understood. Arterial events, including myocardial infarction, are rare but clinically significant and pose a management dilemma. We report the case of a male in his mid-thirties, a sickle cell carrier, diagnosed with metastatic renal cell carcinoma. Following radical nephrectomy, he commenced sunitinib-based chemotherapy. Within months, he developed extensive upper extremity venous thromboses involving the left internal jugular, left subclavian, and left axillary, and, subsequently, an acute ST-elevation myocardial infarction (STEMI), despite being on anticoagulation. Coronary angiogram revealed thrombotic occlusion of the mid-left descending artery, successfully managed with percutaneous coronary intervention. This case highlights the convergence of venous and arterial thrombosis in a patient with RCC receiving TKI therapy, underscoring the potential for life-threatening vascular complications associated with sunitinib, especially in patients with additional prothrombotic predispositions. The elevated thromboembolic risk among patients with metastatic RCC on sunitinib calls for high-quality clinical vigilance. Early recognition, individualized thrombotic risk assessment, and timely intervention are essential for optimizing patient safety and reducing morbidity and mortality during TKI therapy.