Thrombolysis and
PTCA in Simultaneous Infarctions involving Brain and Heart
Sudeep Balakrishan
P.V.S.Hospital,Calicut
Address
for correspondence
Sudeep Balakrishan,
Neurologist,
P.V.S.Hospital,
Calicut 673002
Kerala,India
E-Mail:bsudeep2001@yahoo.co.uk
With reference to the case report on 'A case of
simultaneous infarctions involving brain and heart'[1] I would like
to draw attention to the following factors. Posterior cerebral artery(PCA)territory
infarcts associated with acute myocardial infarction are usually of embolic origin and stand a major risk
of haemorrhagic transformation(HTI).In patients of acute MI with altered neurological status CT head
should be made mandatory prior to thrombolysis. I/V thrombolysis with streptokinase has been reported to
carry a high risk of intra cranial bleed in acute ischemic stroke and would therefore be contraindicated
if neuroimaging reveals coexisiting cerebral infarction.
Although there are no defnite guidelines as of now, primary PTCA might be considered the recanalisation
procedure of choice in such a clinical setting. Even
the delay that may be encountered during transportataion of the patient to an
interventional center might not be a contraindication, considering the clear cut benefits,especially in the setting of
inferior wall infarction.Future clinical trials are needed to comment on outcome measures like lumen
patency and secondary stroke prevention in these subset of patients.
Reference:
[1]Udaya
Bhaskaran V, Prabhu R.A
case of simultaneous infarctions involving brain And heart Calicut
Medical Journal 2003;1(1):e8 URL: http://www.calicutmedicaljournal.org/2003;1(1)e8.htm
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