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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Surgical Transmitral Thrombectomy to Prevent Recurrent Stroke in Acute Myocardial Infarction

Matthias Hasun1, Wilfried Wisser2, Maria Heger1

  • 1Klinik Landstraße, Juchgasse 25, 1030 Wien, Austria.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|September 12, 2022
PubMed

Insights

Left ventricular thrombi can form after acute myocardial infarction despite treatment. Surgical removal is a rare but viable option to prevent dangerous embolism.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Left ventricular thrombi (LV-thrombi) complicate up to 14% of acute myocardial infarction (AMI) cases, even with primary percutaneous coronary intervention.
  • Current AMI guidelines recommend anticoagulant therapy (AC) for patients with LV-thrombi.

Observation:

  • A 46-year-old female patient with AMI developed mobile LV-thrombi despite AC and dual antiplatelet therapy.
  • These mobile thrombi led to a cerebellar stroke, indicating a risk of systemic embolism.

Findings:

  • Surgical thrombectomy via a transmitral approach with endoscopic assistance successfully removed the LV-thrombi.
  • The patient experienced an uneventful postoperative course and a 12-month follow-up.

Implications:

  • Careful monitoring of LV-thrombi morphology is crucial for identifying embolism risk.
  • Surgical thrombectomy represents a rare but effective treatment option for preventing embolism in select cases, requiring careful risk-benefit assessment.

Keywords:
Acute myocardial infarctionCardiac surgeryCoronary artery diseaseVentricular thrombus

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