Shah Adnan, Mughal Sanila, Kumari Usha, Surani Salim, Jan Muneeb
Cardiology, Lady Reading Hospital, Peshawar, PAK.
Medicine, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2023 Sep 20;15(9):e45632. doi: 10.7759/cureus.45632. eCollection 2023 Sep.
Considering the context of percutaneous coronary artery angiography (PCI), stroke is a rare but severe complication and is associated with high morbidity and mortality. A computed tomography (CT) scan of the brain is an indispensable imaging modality to diagnose ischemic stroke changes following PCI. A 75-year-old female who presented with sudden onset chest pain was diagnosed with anterior-wall myocardial infarction which required primary PCI. However, an hour following the procedure, she suddenly developed drowsiness, confusion, and hemiparesis. Non-contrast CT showed hyperdense signals in posterior falx and tentorium cerebelli suggesting subarachnoid hemorrhage (SAH) as well as low attenuation signals in bilateral periventricular region suggestive of microvascular ischemic changes. It was critical to decide about the continuation of dual antiplatelet therapy (DAPT), aspirin and P2Y12 inhibitor, as soon as possible. Based on the clinical presentation and mixed picture on the CT scan, a second opinion was sought by a multidisciplinary team, which concluded that the findings were consistent with white matter stroke and DAPT was resumed. The hemiparesis improved gradually with the reversal of CT scan findings. There is a lack of reported literature about ischemic stroke and SAH following high-risk PCI and what should be the best approach in ambiguous cases. The management of white matter stroke and SAH is contrasting, particularly in deciding whether to continue the DAPT after PCI; hence it is critical to diagnose them promptly. Thus, this case highlights the importance of differentiating SAH from white matter stroke for prompt treatment of post-PCI complications to ensure positive outcomes.
考虑到经皮冠状动脉造影术（PCI）的背景，中风是一种罕见但严重的并发症，与高发病率和死亡率相关。脑部计算机断层扫描（CT）是诊断PCI后缺血性中风变化不可或缺的成像方式。一名75岁女性因突发胸痛就诊，被诊断为前壁心肌梗死，需要进行急诊PCI。然而，术后一小时，她突然出现嗜睡、意识模糊和偏瘫。非增强CT显示大脑镰后部和小脑幕有高密度信号，提示蛛网膜下腔出血（SAH），双侧脑室周围区域有低密度信号，提示微血管缺血性改变。尽快决定是否继续使用双联抗血小板治疗（DAPT），即阿司匹林和P2Y12抑制剂，至关重要。基于临床表现和CT扫描的混合图像，多学科团队寻求了第二种意见，结论是这些发现与白质中风一致，于是恢复了DAPT治疗。随着CT扫描结果的好转，偏瘫逐渐改善。关于高危PCI后缺血性中风和SAH以及在不明确病例中最佳处理方法的报道文献较少。白质中风和SAH的处理方法截然不同，尤其是在决定PCI后是否继续DAPT方面；因此，及时诊断它们至关重要。因此，该病例突出了区分SAH和白质中风对于及时治疗PCI后并发症以确保良好结果的重要性。
