A young adult with internal carotid artery occlusion during finasteride therapy: pathological findings from a thrombus retrieved by mechanical thrombectomy

A 40-year-old man undergoing treatment for male pattern baldness with finasteride (1 mg/day) and minoxidil (10 mg/day) experienced a stroke due to left internal carotid artery occlusion, despite having no apparent risk factors. A dark red thrombus, primarily composed of red blood cells and fibrin, was retrieved through mechanical thrombectomy. This case is a rare report where the thrombus was pathologically evaluated while the patient was on both medications. It is suggested that finasteride may enhance coagulation through estrogen dominance due to androgen suppression, while minoxidil might contribute to the condition by lowering blood pressure. Similar cases of stroke during the use of these medications have been reported in Japan, and this report includes pathological and literature-based considerations.