Stroke and Recurrent Thrombosis of the Coronary Arteries Probably due to Patent Foramen Ovale and Antebrachial Vein Thrombosis in Patient with STEMI - Case Report.

Abstract

A 74-year-old woman with a history of cryptogenic stroke in 2010 (during hospitalization at the neurological department, possible reasons of stroke were excluded at that time), with less than one year history of paroxysmal atrial fibrillation (AF), which was being treated with apixaban, and also exhibiting hypertension, diabetes type II, hypothyreotocsicosis and obesity, was admitted to our hospital twice. For the first time, the patient was admitted due to ST segment elevation myocardial infarction (STEMI) and an episode of AF. Coronary angiography revealed occlusion of the left circumflex coronary (LCX) artery, and percutaneous coronary intervention (PCI) with stent implantation was performed. Conversions of AF episodes to the sinus rhythm were spontaneous. The patient was discharged home and readmitted once again three days after the discharge. STEMI of the anterior wall and a new episode of AF were then diagnosed. Immediate plain old balloon angioplasty (POBA) with implantation of an additional stent in the left anterior descending coronary artery (LAD) was performed. Sixty minutes after the procedure, the patient developed symptoms of mild right-sided pyramidal syndrome and slight aphasia. The patient's status was assessed, scoring 3 points according to the National Institute of Health Stroke Scale (NIHSS), and the patient was not qualified for thrombolysis and mechanical thrombectomy of the cerebral artery. Four days after manifesting the symptoms of stroke, CT did not reveal any new significant lesions of the brain, and, on the eighth days after the stroke, aphasia almost completely disappeared. A thrombus in the left atrium appendage was excluded, and a patent foramen ovale (PFO) with the left-to-right flow was revealed. Due to the risk of reverse flow as a possible reason of strokes (now and 15 years ago) and recurrent thromboembolization of coronary arteries along with the presence of thromboembolization of the antebrachial vein, successful occlusion of PFO with an Amplatzer Septal Occluder was performed. The patient was discharged home in good condition.