Emergency endovascular treatment of cardioembolic stroke in the early post-infarction period with subsequent direct myocardial revascularization

Abstract

Introduction. Ischemic stroke (IS) remains one of the significant problems of modern medicine to this day. Cardioembolic stroke (CEI) accounts for 20 % of all cases of IS and is characterized by acuteness, severity of the disease and high mortality.Aim of study. An observation is presented in patient Sh., 51 years old, who was urgently transferred from another medical institution on the 3rd day after the development of acute recurrent anterior myocardial infarction with ST segment elevation complicated by early post-infarction angina pectoris. During the additional examination, in addition to severe multifocal atherosclerosis and multivessel coronary artery disease, a floating thrombus in the cavity of the left ventricle was detected. At the stage of preparing the patient for coronary artery bypass grafting, the patient developed stroke. Thrombextraction from the basilar artery (BA) was performed urgently. As a result, a complete regression of neurological symptoms was achieved. This made it possible to continue the preparation and successfully perform coronary artery bypass grafting. The patient was discharged on the 10th day after the operation, the entire hospitalization period was 28 bed-days.Discussion. In the presented case, a patient with a clinic of unstable angina pectoris, severe multifocal atherosclerosis, and multivessel coronary artery disease was in a specialized multidisciplinary hospital at the time of the development of stroke. The well-coordinated work of the multidisciplinary team, the possibility of performing thromboaspiration in the shortest possible time allowed not only to save the patient's life and achieve complete regression of neurological symptoms, but also to improve the quality of life through surgical treatment of coronary heart disease.

Keywords

• cardioembolic stroke
• basilar artery thrombosis
• endovascular thrombaspiration
• early postinfarction period