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Cerebrovascular accident associated with dipyridamole thallium-201 myocardial imaging: case report
J H Whiting1, F L Datz, F V Gabor
1Department of Radiology, University of Utah School of Medicine, Salt Lake City.
Insights
Dipyridamole-201Tl myocardial studies can precipitate strokes in high-risk patients. Dipyridamole-induced vascular steal is the likely cause, necessitating careful patient selection for this cardiac imaging procedure.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Aortoiliac occlusive disease and hypertension are significant risk factors for cerebrovascular events.
- Dipyridamole-201Tl myocardial imaging is a stress test used to evaluate coronary artery disease.
Observation:
- A patient with known aortoiliac occlusive disease and hypertension experienced a cerebrovascular accident shortly after intravenous dipyridamole administration during a 201Tl myocardial study.
- The stroke occurred despite the administration of aminophylline, a potential antidote.
Findings:
- The most probable mechanism for the stroke was dipyridamole-induced vascular steal, a phenomenon where the drug diverts blood flow away from compromised cerebral arteries.
- While generally safe, dipyridamole-201Tl myocardial imaging carries a risk of cerebrovascular accidents, particularly in patients with pre-existing stroke risk factors.
Implications:
- Clinicians must carefully assess patients for stroke risk factors before performing dipyridamole-201Tl myocardial studies.
- This case highlights the critical need to consider the potential for dipyridamole-induced vascular steal and subsequent cerebrovascular events in susceptible individuals.
Abstract:
A patient with known aortoiliac occlusive disease and hypertension suffered a cerebrovascular accident 6.5 min after the administration of intravenous dipyridamole during a 201Tl myocardial study. Despite aminophylline administration, the patient developed a completed stroke. The mechanism most likely responsible for precipitating this patient's stroke is dipyridamole-induced vascular steal. Although dipyridamole-201Tl myocardial imaging is relatively free of major complications, the morbidity and mortality associated with a cerebrovascular accident is significant. The possibility of precipitating a cerebrovascular accident during dipyridamole-201Tl imaging should be considered in all patients with significant risk factors for stroke before performing a dipyridamole cardiac study.