Fitzek Sabine, Fitzek Clemens
Departments of *Neurology †Radiology and Neuroradiology, Asklepios Fachklinikum Brandenburg, Brandenburg, Germany.
Neurologist. 2015 Sep;20(3):46-7. doi: 10.1097/NRL.0000000000000046.
There are reports of an ischemic stroke during intravenous recombinant tissue-type plasminogen activator (rtPA) for evolving myocardial infarction (MI), and the risk of stroke shortly after an acute MI seems to be higher than in the control population, attributed to intracardiac thrombus formation.
We report a case of fatal MI developing immediately after the start of rtPA infusion for middle cerebral artery stroke in an 88-year-old woman. We assume that the systemic thrombolysis with rtPA led to the fragmentation of an underlying cardiac thrombus, which embolized and occluded the coronary artery and caused MI. This hypothesis is discussed with respect to a short review of the related literature.
An embolic MI seems to be a rare but serious complication in thrombolysis therapy with rtPA.
有关于在静脉注射重组组织型纤溶酶原激活剂（rtPA）治疗进展性心肌梗死（MI）过程中发生缺血性卒中的报道，急性心肌梗死后不久发生卒中的风险似乎高于对照组人群，这归因于心内血栓形成。
我们报告一例88岁女性在开始使用rtPA治疗大脑中动脉卒中后立即发生致命性心肌梗死的病例。我们推测rtPA的全身溶栓导致潜在心脏血栓破碎，血栓栓塞并阻塞冠状动脉，从而引起心肌梗死。结合相关文献的简短回顾对这一假说进行了讨论。
在rtPA溶栓治疗中，栓塞性心肌梗死似乎是一种罕见但严重的并发症。
