Significant cisplatin-associated carotid artery thrombosis treated and successfully rechallenged with cisplatin in a patient with testicular cancer

Introduction: Cisplatin-based systemic chemotherapy remains the cornerstone of treatment of testicular germ cell tumors, yet it carries a significant risk of thromboembolic complications. Although venous thromboembolism is more frequently reported, arterial thrombotic events (ATEs)—including ischemic stroke—represent a serious but underrecognized complication that can occur acutely, even after one treatment cycle. Case Report: This case report describes a 29-year-old male with metastatic mixed germ cell tumor who developed acute left-sided hemiparesis and dysarthria on day 7 of cycle one etoposide-cisplatin. Imaging revealed total right internal carotid artery occlusion with evolving middle cerebral territory infarction. The patient underwent urgent thrombolysis and thrombectomy with excellent neurological recovery and complete resolution of deficits. Potential contributing factors included a history of smoking and chronic tonsilitis. Following repeated multidisciplinary discussions, the patient was rechallenged with further three cycles of cisplatin and etoposide concurrently with anticoagulation and close monitoring. He achieved a complete biochemical response and subsequently complete radiological response after retroperitoneal lymph node dissection (RPLND). Conclusion: This case report raises few critical points: including the importance of maintaining high index of suspicion for acute thromboembolism, particularly in patients with associated risk factors; the paramount value of various multidisciplinary team members, including stroke team, interventional radiology and neurology services; and the rechallenge with cisplatin remains the most critical decision. The use of carboplatin for cisplatin not only offers inferior results but may even be associated with higher thromboembolic risk and finally given the curative treatment intention in this young, otherwise healthy young population, continued appropriate anticoagulation therapy with vigilant monitoring represent fundamental approach. Our case adds to the sparse data on cisplatin-associated arterial thromboembolism and highlight the urgent need for universal management guidelines.