Multimodal management of rheumatic mitral stenosis with widespread cervicocephalic thromboembolism

BACKGROUND: Rheumatic mitral stenosis is commonly associated with left atrial enlargement and impaired flow, predisposing to thrombus formation. Left atrial thrombi increase the risk of systemic embolization and cerebrovascular ischemia. Antithrombotic therapy is essential to reduce embolic risk and to bridge patients to surgical valve intervention. CASE PRESENTATION: A 36-year-old woman with rheumatic mitral stenosis complicated by left atrial thrombi presented with multi-vessel occlusion within the cervicocephalic circulation, resulting in cerebellar infarction. Dual antithrombotic therapy was followed by partial recanalization, enabling successful mitral valve replacement. Postoperative anticoagulation was maintained and effectively prevented recurrence. CONCLUSIONS: This case highlights rheumatic mitral stenosis complicated by extensive cervicocephalic thromboembolism. The findings underscore the high embolic risk of left atrial appendage thrombosis in young patients. Dual antithrombotic therapy with rivaroxaban (anticoagulant) and aspirin (antiplatelet) was followed by partial recanalization and neurological stabilization, serving as a bridge to surgery. Delayed valve replacement after cerebral infarction minimized perioperative bleeding risk and ensured a favorable outcome. These findings emphasize the importance of individualized antithrombotic therapy and careful surgical planning in complex valvular disease.