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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(08): 690-691
DOI: 10.1590/0004-282X20160099
IMAGES IN NEUROLOGY

Early reperfusion therapy in acute ischemic stroke after recent myocardial infarction

Otimizando os benefícios da terapia de reperfusão precoce no AVC agudo após infarto agudo do miocárdio
Gustavo Wruck Kuster
1   Hospital Total Cor, São Paulo SP, Brasil;
2   Hospital Paulistano, São Paulo SP, Brasil;
,
Antonio Claudio Baruzzi
1   Hospital Total Cor, São Paulo SP, Brasil;
,
Evelyn de Paula Pacheco
1   Hospital Total Cor, São Paulo SP, Brasil;
2   Hospital Paulistano, São Paulo SP, Brasil;
,
Renan Barros Domingues
1   Hospital Total Cor, São Paulo SP, Brasil;
2   Hospital Paulistano, São Paulo SP, Brasil;
,
Marco Pieruccetti
2   Hospital Paulistano, São Paulo SP, Brasil;
,
Luciano Marcus Tirotti Giacon
2   Hospital Paulistano, São Paulo SP, Brasil;
,
Jose Carlos Teixeira Garcia
1   Hospital Total Cor, São Paulo SP, Brasil;
,
Valter Furlan
1   Hospital Total Cor, São Paulo SP, Brasil;
,
Ayrton Roberto Massaro
3   Hospital Sírio Libanês, São Paulo SP, Brasil.
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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].

Zoom Image
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).

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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Martins SCO, Freitas GR, Pontes-Neto OM, et al. Guidelines for acute ischemic stroke treatment – Part II: Stroke treatment. Arq Neuropsiquiatr. 2012;70(11):885 -93. doi:10.1590/S0004-282X2012001100012
  • 2 Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM et al. Guidelines for the early management of patients with an acute ischemic stroke: a guideline for Healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2013;44(3):870-947. doi:10.1161/STR.0b013e318284056a
  • 3 Hussain SI, Zaidat OO, Fitzsimmons BF. The Penumbra system for mechanical thrombectomy in endovascular acute ischemic stroke therapy. Neurology. 2012;79(13 Suppl 1):135-41. doi:10.1212/WNL.0b013e31826958a8
  • 4 Widimsky P, Coram R, Abou-Chebi A. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences. Eur Heart J. 2014;35(3):147-55. doi:10.1093/eurheartj/eht409
  • 5 Singer OC, Haring HP, Trenkler J, Nolte CH, Bohner G, Neumann-Haefelin T et al. Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry. Neuroradiology. 2013;55(9):1143-51. doi:10.1007/s00234-013-1219-9

Address for correspondence

Gustavo W Kuster
Rua Morgado de Mateus, 259 / apto 11; 04015-050 São Paulo SP
Brasil   

Publication History

Received: 29 August 2015

Accepted: 16 May 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Martins SCO, Freitas GR, Pontes-Neto OM, et al. Guidelines for acute ischemic stroke treatment – Part II: Stroke treatment. Arq Neuropsiquiatr. 2012;70(11):885 -93. doi:10.1590/S0004-282X2012001100012
  • 2 Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM et al. Guidelines for the early management of patients with an acute ischemic stroke: a guideline for Healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2013;44(3):870-947. doi:10.1161/STR.0b013e318284056a
  • 3 Hussain SI, Zaidat OO, Fitzsimmons BF. The Penumbra system for mechanical thrombectomy in endovascular acute ischemic stroke therapy. Neurology. 2012;79(13 Suppl 1):135-41. doi:10.1212/WNL.0b013e31826958a8
  • 4 Widimsky P, Coram R, Abou-Chebi A. Reperfusion therapy of acute ischaemic stroke and acute myocardial infarction: similarities and differences. Eur Heart J. 2014;35(3):147-55. doi:10.1093/eurheartj/eht409
  • 5 Singer OC, Haring HP, Trenkler J, Nolte CH, Bohner G, Neumann-Haefelin T et al. Periprocedural aspects in mechanical recanalization for acute stroke: data from the ENDOSTROKE registry. Neuroradiology. 2013;55(9):1143-51. doi:10.1007/s00234-013-1219-9

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Zoom Image
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).