Manea Maria Mirabela, Dragoş Dorin, Stoica Emanuel, Bucşa Adrian, Marinică Ioana, Tuţă Sorin
National Institute of Neurology and Neurovascular Diseases.
"Carol Davila" University of Medicine and Pharmacy.
Medicine (Baltimore). 2018 Dec;97(50):e13347. doi: 10.1097/MD.0000000000013347.
Acute ST-segment elevation myocardial infarction (STEMI) is a rare complication of acute ischemic stroke (AIS) during thrombolytic therapy. We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches.
A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block).
The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion.
Four hours after the onset of STEMI, stenting was performed, normalizing the coronary blood flow.
The patient died 2 days thereafter because of persistent cardiogenic shock.
Our case is remarkable owing to the unusually early (<1 hour) occurrence of STEMI after i.v. rtPA administration. A third-degree atrioventricular block after thrombolysis for AIS could signal a STEMI onset. New and ongoing trials are assessing whether adjunct administration of direct thrombin inhibitors of rtPA in the first 24 hours after thrombolysis for AIS can prevent early recurrent ischemic events.
急性ST段抬高型心肌梗死（STEMI）是急性缺血性卒中（AIS）溶栓治疗期间罕见的并发症。我们报告1例AIS溶栓治疗40分钟后发生STEMI的病例，并讨论可能的机制和治疗方法。
一名87岁有动脉高血压病史的女性，在抵达急诊科前2小时因急性右侧肢体无力入院。在对AIS静脉注射重组组织型纤溶酶原激活剂（i.v. rtPA）40分钟后，发生了STEMI（表现为三度房室传导阻滞）。
诊断为AIS和STEMI。冠状动脉造影证实右冠状动脉闭塞。
STEMI发作4小时后进行了支架置入术，使冠状动脉血流恢复正常。
患者此后2天因持续性心源性休克死亡。
我们的病例很特殊，因为在静脉注射rtPA后STEMI异常早期（<1小时）发生。AIS溶栓后出现三度房室传导阻滞可能预示STEMI发作。正在进行的新试验正在评估在AIS溶栓后最初24小时内联合使用rtPA的直接凝血酶抑制剂是否能预防早期复发性缺血事件。
