Early reperfusion therapy in acute ischemic stroke after recent myocardial infarction

A 50-year-old woman with recent myocardial infarction (MI), presented right hemiparesis with aphasia (National Institutes of Health Stroke Scale: 18), 24 hours after the coronary angiogram that revealed a large apical thrombus ([Figure 1A]). Computed tomography demonstrated left middle cerebral artery (MCA) “dot” sign ([Figure 1B]). Angiography showed occlusion in the MCA second segment ([Figure 1C]) with recanalization after mechanical thrombectomy ([Figure 1D]). She presented a complete recovery (Rankin: 0) and after 9 days she was discharged with oral anticoagulation. Recent MI within previous 3 months is a contraindication to IV thrombolysis (myocardial rupture)[1],[2]. Mechanical thrombolysis seems to be a safe and effective alternative in this situation[3],[4],[5].

Figure 1 (A) Computed tomography demonstrated a left middle cerebral artery “dot” sign (arrowhead); (B) Coronary angiogram revealed an apical myocardial disfunction with a large thrombus; (C) Cerebral angiogram demonstrated an occlusion; (D) Recanalization after an endovascular procedure using a mechanical device (Penumbra system).

• References

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