No abstract

The complication of myocardial infarction after using intravenous recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke is rare. Several of these cases have been reported in the first 3 hours after infusion of rt-PA. There is controversy on how to manage treatment of the coronary artery, such as intravenous anticoagulants and antiplatelets, at the same time. We introduce a new strategy for treatment of a patient who had ischemic stroke and developed myocardial infarction after intravenous rt-PA therapy. Our case had coronary and cerebral intervention in combination with low-dose intravenous rt-PA. He was successfully treated for coronary occlusion with aspiration thrombectomy.

BACKGROUND: Thrombectomy is recommended to treat for an acute ischemic stroke (AIS) patient with anterior large vessel occlusion. However, there were neither detailed guidelines nor systematic reviews of acute ischemic stroke patients having multiple times or re-occluded arteries. CASE REPORT: In our case report, we struggled a multiple (4-times) AIS patient underwent by one intravenous r-tpA and 3 remaining of endovascular treatment of thrombectomy. Especially, the finding of both pulmonary embolism and cerebral arteries occlusion in this patient made us difficult to decide the appropriate treatment plan. The patient was considered having multiple cardiac thrombi pumping out to the brain and pulmonary vessels even in treatment with NOAC (New Oral Anticoagulant). Our priority, normally, was to recanalize the brain vessels compared to the pulmonary arteries. CONCLUSION: In conclusion, based on this noticed case study, we want to share our experiences on the diagnosis of ischemic stroke, the strategy in treatment and prevention with anticoagulant therapy.

To improve the rate of patients with ischemic stroke who have treated with Alteplase and effective treatment, Pho Noi General Hospital has applied a multimodal intervention model in the pre-hospital and in-hospital stages, and after discharge. This study aims to evaluate the results of the model at Pho Noi General Hospital from January 2021 to June 2022 particularly the rate of early admits and the clinical outcome, and comparing with the period 2018 – 2020, which has not applied the intervention model. The study showed that 29,5% and 34,4% of patients came early at the 4.5 hour and 6 hours window after symptom onset, respectively, which were statistically significantly higher when they had compared with the period 2018-2020. The door-needle time in the post-intervention period was 45,5 minutes, which was statistically significantly lower than in the pre-intervention period, which was 50,9 minutes. Patients being in the post-intervention stage had the rate of mRS 0-2 at discharge of 47,9%, which was statistically significantly higher than in the pre-intervention period of 41.6%. Conclusion: Our study shows that, after 1.5 years of applying the multimodal intervention model in the management of stroke patients in Pho Noi General hospital, the proportion of patients arriving early within the 4.5-hour and 6 hours window increased; decreased needle-to-door time and increased mRS 0-2 rate at discharge. Key word: Acute ischemic stroke, thrombolysis, clinical outcome, reperfusion treatment.