London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 359 147 Interesting and challenging cases SIMULTANEOUS STROKE AND ACUTE MYOCARDIAL INFARCTION IN PATIENT WITH ESSENTIAL THROMBOCYTHEMIA A. MARTIN MONTES1, B. FUENTES GIMENO2, P. MARTINEZ SANCHEZ3, G. RUIZ ARES4, M.A. MANGAS GUIJARRO5, E. BLANCO VICENTE6, O. TRABAJOS GARCÍA7, E. DIEZ TE-JEDOR8 LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AU-TONOMA UNIVERSITY OF MADRID., MADRID, SPAIN1, LA PAZ UNIVERSITY HOSPI-TAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AUTONOMA UNIVERSITY OF MADRID., MADRID, SPAIN2, LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTI-TUTE. AUTONOMA UNIVERSITY OF MADRID., MADRID, SPAIN3, LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AUTONOMA UNIVERSITY OF MA-DRID., MADRID, SPAIN4, LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AUTONOMA UNIVERSITY OF MADRID., MADRID, SPAIN5, LA PAZ UNIVER-SITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AUTONOMA UNIVERSITY OF MADRID., MADRID, SPAIN6, LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RE-SEARCH INSTITUTE. AUTONOMA UNIVERSITY OF MADRID., MADRID, SPAIN7, LA PAZ UNIVERSITY HOSPITAL. IDIPAZ HEALTH RESEARCH INSTITUTE. AUTONOMA UNIVER-SITY OF MADRID., MADRID, SPAIN8 Introduction: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by sustained thrombocytosis in peripheral blood and bone marrow megakaryocytic hyperplasia present-ing thrombotic complications in 2.6 per 100 patients per year, corresponding to only 3-4% of those with thrombosis of large vessels. We report the case of a patient with ET and simultaneous stroke and myocardial infarction (MI). Case description: 50 year old male with a history of ET, two prior acute MI and stroke in territo-ry of left middle cerebral artery (MCA), with mild residual right hemiparesis. He was found with decreased level of consciousness, right weakness and aphasia. The electrocardiogram showed ST segment elevation in II, III and aVF. He arrived at the hospital with an hour and a half of evolution, hemodynamically unstable with hypotension and desaturation, requiring intubation and vasoactive drugs. Urgent cranial computed tomography showed old ischemic lesions in the territory of left MCA and transcranial color Doppler ultrasound showed occlusion of the left MCA from the distal M1 segment. After being evaluated by Neurology and Cardiology, he was treated with intravenous thrombolysis. Neurointerventional procedure was dismissed by hemodynamic instability. Coronary angiography was performed with stent placement in the right coronary artery. The patient improved but a neurological deficit persisted (NIHSS scale: 17). Peripheral blood thrombocytosis maintained in figures reaching 1,400,000 platelets/mm3. The echocardiogram showed akinesic areas, but antico-agulation was considered to be contraindicated due to the risk of bleeding because of ET. Conclusions: We report the case of a patient with ET who presented simultaneously stroke and acute MI. This case raises the discussion on the possibility of a neurointerventional procedure despite of hemodynamic instability and the risk of oral anticoagulation in ET.
Karger_ESC London_2013
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