Spontaneous coronary thrombosis following thrombolytic therapy for acute cardiovascular accident and stroke: a case study

Abstract

Cardiac complications following stroke or acute cerebrovascular accidents (CVA) are common; however, many of these complications are asymptomatic and do not cause adverse cardiac effects. Symptomatic events (such as acute myocardial infarction after CVA) rarely occur and are often the result of an underlying cardiac embolic source, such as a left ventricular thrombus. We report a case of spontaneous coronary thrombosis following thrombolytic therapy for acute CVA, and discuss the implication that an underlying systemic pro-thrombotic state may predispose individuals to thrombosis in disparate vascular beds.

Coronary aspiration thrombectomy after using intravenous recombinant tissue plasminogen activator in a patient with acute ischemic stroke: a case report

“…Three patients who had this therapy were reported, and fortunately, they all survived without intracranial hemorrhagic complications. 2,3,10 This finding indicates the importance of antiplatelets/anticoagulants for preserving the patient’s life to keep their stents from re-occlusion. In our patient, we performed an emergency coronary intervention with the strategy of aspiration thrombectomy without a coronary stent.…”

Does intravenous administration of recombinant tissue plasminogen activator for ischemic stroke can cause inferior myocardial infarction?

“…In the cases that presented with Stewa et al . 9 and Wallace et al , 7 also the patients developed an inferior MI following administration of rTPA. It is not clear if there is any direct correlation between rTPA injection and occurrence of inferior MI, or maybe there is an identical etiology for both of ischemic stroke and inferior MI, as we encounter in aortic dissection.…”

“…There may be an underlying cardiac embolic source for both ischemic stroke and acute myocardial infarction such as a left ventricular thrombus. 7 Embolic stroke to insula can cause autonomic dysfunction and cardiac arrhythmia which can cause ischemia of myocardium due to increasing demand of premorbid coronary arteries. 8 Several conditions such as aortic dissection, large vessel arteritis and endocarditis can induce myocardial infarction and ischemic stroke, simultaneously.…”

“…An indication of acute myocardial infarction after administration of rTPA for ischemic stroke is increasingly reported. 7 , 9 , 10 In this study, we described a patient with previous cardiovascular risk factors who was complicated with acute myocardial infarction following prescription of rTPA for an acute ischemic stroke.…”

Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions

“…Thromboembolic complications of IVT in the setting of AMI have been described in 1.5% of patients [124]. Our literature search identified the following complications of IVT for AIS symptoms in patients with concomitant intracardiac thrombi: nine cases of AMI due to distal embolization in coronary arteries, two cases of peripheral arterial embolism and three cases of recurrent embolic AIS (Supplementary Table 2) [125][126][127][128][129][130][131][132][133][134]. However, it should be noted that the intracardiac thrombi were not visualized in the majority of these cases, but the presence of multiple emboli in different arterial territories was strongly suggestive of the presence of intracardiac thrombus.…”