Ischemic stroke complicating thrombolytic therapy with tenecteplase for ST elevation myocardial infarction: two case...

Area of Science:

• Cardiology
• Neurology

Background:

• Thrombolytic therapy, including tenecteplase, is a critical treatment for ST elevation myocardial infarction (STEMI).
• Hemorrhagic complications are known risks associated with thrombolysis.
• Ischemic stroke following thrombolysis for STEMI is an exceptionally rare and paradoxical event.

Observation:

• Two cases of STEMI treated with tenecteplase are presented.
• The first patient, a 56-year-old African man, experienced an ischemic stroke minutes after thrombolysis.
• The second patient, a 65-year-old African man, developed an ischemic stroke 10 hours post-thrombolysis.

Findings:

• These cases illustrate that ischemic stroke can occur as a complication of fibrinolytic therapy for STEMI.
• The occurrence of ischemic stroke contrasts with the more common hemorrhagic complications of thrombolysis.
• The underlying pathophysiology linking fibrinolytic therapy and subsequent ischemic stroke remains poorly understood.

Implications:

• Clinicians should be aware of the potential for ischemic stroke as a rare complication of STEMI thrombolysis.
• Further research is needed to elucidate the mechanisms behind this paradoxical neurological event.
• Understanding these mechanisms may lead to improved patient management and risk stratification strategies.