Intracerebral Hemorrhage Following Second Percutaneous Transluminal Coronary Angioplasty

Intracranial hemorrhage (ICH) is the most devastating bleeding complication of percutaneous coronary intervention (PCI). It is also considered rare and is therefore often overlooked, even in patients at high risk of bleeding. Its occurrence during the second PCI procedure has rarely been reported in the existing literature. An elderly man aged 77 years presented to our tertiary specialized center cardiology outpatient clinic with complaints of diffuse chest pain for 7 days, heaviness type, exacerbating on exertion, relieved on taking rest, lasting for 5–10 min, and not radiating to any other sites. It was associated with light-headedness and dizziness. The diagnosis made was Massive fronto-temporoparietal ICH.Percutaneous transluminal coronary angioplasty (PTCA) of the left circumflex and right coronary arteries was performed; however, he developed massive ICH with midline shift during the second setting of PTCA to the left anterior descending artery and underwent emergency fronto-temporoparietal decompressive craniotomy for clot evacuation. Supportive fluid, electrolyte correction, glucose control, ventilatory support, and inotrope infusions were continued in the intensive care unit. There was a progressive improvement in metabolic acidosis with ongoing treatment. On the 4th postoperative day, the inotropic requirements of noradrenaline, adrenaline, and vasopressin progressively increased due to worsening hemodynamics, and the patient did not survive. This case highlights the need for rapid neurological assessment and early neuroimaging in high-risk patients presenting with acute neurological collapse after PCI.