Ischemic stroke complicating thrombolytic therapy with tenecteplase for ST elevation myocardial infarction: two case reports

Arous, Salim; Haboub, M.; Benouna, Mohamed El Ghali; Bentaoune, Tarik; Habbal, Rachida

doi:10.1186/s13256-017-1322-3

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…An interesting finding in the group of patients who received fibrinolysis was a case of ischemic cerebrovascular event not related to atrial fibrillation, this is a very rare complication with a not well clarified pathophysiology, although several mechanisms have been proposed [ 23 ]. A large registry indicated that the incidence of in-hospital ischemic stroke after STEMI is about 1.2%, increasing the risk of mortality, and the factors associated include: age, female gender, atrial fibrillation, history of cerebrovascular accident, heart failure, diabetes mellitus, chronic renal failure, carotid artery disease, aortic disease, left ventricle thrombus, left ventricle aneurysm, acute or chronic deep venous thrombosis/pulmonary embolism, hypercoagulable state, and coronary artery bypass grafting [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country

Chacón-Díaz

Custodio-Sánchez

Cuba

et al. 2022

BMC Cardiovasc Disord

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Objective The primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). The pharmacoinvasive strategy (PIs) is a reasonable alternative when prompt PPCI is not possible, especially in resource-limited regions. We aimed to compare PPCI versus PIs outcomes in Peru. Methods This was a retrospective cohort study based on the second Peruvian Registry of STEMI (PERSTEMI II). We compared the characteristics, in-hospital outcomes and 30-day mortality of patients undergoing PPCI during the first 12 h and those receiving a PIs. A propensity score-matched analysis was conducted to compare the effects of each treatment strategy on clinical outcomes. Results PIs patients were younger than PPCI patients, had a shorter first medical contact time, first medical contact to reperfusion time, and total ischemic time until reperfusion. Successful PCI was more frequent in the PIs group (84.4% vs. 71.1%, p = 0.035). There were no differences between PIs and PPCI in terms of total in-hospital mortality (5.2% vs. 6.6%, p = 0.703), cardiovascular mortality (4.2% vs. 5.3%, p = 0.735), cardiogenic shock (8.3% vs. 13.2%, p = 0.326), heart failure (19.8% vs. 30.3%, p = 0.112), or major bleeding (0% vs. 2.6%, p = 0.194). In the propensity score-matched analysis, the rates of cardiovascular mortality, postinfarction heart failure and successful reperfusion were similar. Conclusions In this real-world study, no differences were found in the in-hospital outcomes between patients with STEMI who received PIs or PPCI.

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Section: Discussionmentioning

confidence: 99%

Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country

Chacón-Díaz

Custodio-Sánchez

Cuba

et al. 2022

BMC Cardiovasc Disord

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“…The pathophysiological processes underlying ischemic strokes following AMI are complex. Ischemia causes a systemic procoagulant response, facilitating the formation of cardiac thrombuses and embolization [12] . The patient had an inferior MI, which is unusual as a cause of thrombus formation and can be a possible explanation for the acute ischemic stroke due to the brinolysis of that thrombus.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Infarction Complicated by Acute Ischemic Stroke due to Alteplase

Hassan¹,

Waberi²,

Hassan³

et al. 2022

Preprint

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The early reperfusion therapy with tissue plasminogen activator (tPA) for acute myocardial infarction (MI) in the first 12 hours outweighs its risks. One of the known major complications of tPA is intracerebral hemorrhage (ICH). A rare and unexpected complication following the administration of thrombolytic treatment is acute ischemic stroke. Our case study is a 54-year-old lady with an acute myocardial infarction who received antifibrinolytic medication and paradoxically experienced an abrupt ischemic stroke. This case highlights a rare but dangerous complication of an acute ischemic stroke.

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“…In another analysis, anterior wall MI was associated with an increased risk of stroke (AOR, 1.16; 95% CI, 1.10-1.22; p=0.001). "Echocardiographic studies indicate that most patients with visible mural thrombi have anterior wall infarction, whereas patients with good left ventricular function and inferior wall infarction rarely have detectable thrombi" [8,9]. "Substance abuse, including alcohol abuse and cocaine abuse/dependence, has also been linked to post-MI CVA" [10].…”

Section: Fig 2 Ct Scan Showing a Right Sylvian Artery Stroke With Sub...mentioning

confidence: 99%

Ischemic Stroke Following Thrombolytic Therapy for Acute Inferior Myocardial Infarction: The Third Reported Case

Abouriche

Bendahou

Laklalech

et al. 2022

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Background: Ischemic stroke following thrombolysis for ST-segment elevation myocardial infarction(STEMI) is a rare and perplexing complication. We present an intriguing case of ischemic stroke following fibrinolytic therapy with tenecteplase for a STEMI. This is an extremely rare condition, and our case appears to be the third one reported in our departement. The three cases had one thing in common: ST-segment elevation in the inferior leads. Case Presentation: We describe the case of a 50-year-old north-african woman who suffered an acute inferior STEMI 6 hours after chest pain onset. Thrombolysis with tenecteplase was performed and few hours later an extensive right sylvian artery stroke occurred with subfalcine herniation. Decision-Making: The refractory intracranial hypertension despite medical therapy compelled a decompressive craniectomy. On the follow up, neurological deficits had increased, congestive heart failure developed, and finally the patient died on the tenth day in the intensive care unit. Conclusion: Hemorrhagic complications are not the only one, ischemic stroke can also occur after thrombolysis even if it is extremely odd. The pathophysiology is still poorly established. The prevalent implication of the inferior territory in the three cases described in the literature may open to future research prospects.

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Ischemic stroke complicating thrombolytic therapy with tenecteplase for ST elevation myocardial infarction: two case reports

Cited by 5 publications

References 13 publications

Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country

Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country

Myocardial Infarction Complicated by Acute Ischemic Stroke due to Alteplase

Ischemic Stroke Following Thrombolytic Therapy for Acute Inferior Myocardial Infarction: The Third Reported Case

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