Key result
Combined endovascular approach successfully manages concurrent NSTEMI and unruptured intracranial aneurysm without complications.
Why the study?
Managing concomitant intracranial aneurysm with risk of rupture and acute myocardial infarction presents therapeutic challenges, particularly regarding anticoagulation and simultaneous endovascular treatment.
Case Report (n=1)
No
A combined endovascular approach can be successfully and safely performed in patients presenting with acute coronary syndrome and a concomitant high-risk intracranial aneurysm.
Answers are grounded in this paper and cite their sources.
May support combined endovascular approach in select ACS cases with unruptured aneurysm; leaves open need for prospective validation.
Introduction: Cerebrovascular and cardiovascular syndromes have the highest morbidity and mortality rates worldwide.An increase in the prevalence of unruptured intracranial aneurysms has been observed as a result of the evolution of non-invasive imaging techniques, most of which are asymptomatic until the moment of rupture.Preventive treatment is indicated when the risk of bleeding outweighs the risks of treatment.Objective: To report the case of a septuagenarian patient admitted to Hospital das Clínicas Costantino Ottaviano with acute non-ST elevation myocardial infarction, who was observed concomitantly with aneurysmal dilation at the level of the middle cerebral artery branch with risk of rupture, who underwent combined endovascular approach in the hemodynamics room, which led to a favorable outcome, highlighting the challenges of the simultaneous endovascular approach.Method: A retrospective analysis of the patient's medical records was performed concomitantly with the narrative review with an active search in the PubMed database.Conclusion: Although the diagnosis of intracranial aneurysm associated with coronary syndrome requiring anticoagulation is a challenge for the clinician, the combined endovascular approach offers the possibility of a successful and minimally invasive treatment for a potentially catastrophic condition.Currently, HCTCO provides high-performance intensive and cardiointensive medicine services, in addition to the new hemodynamics laboratory, where the endovascular approach was successfully performed, providing a lower risk of complications, greater survival and improvement in the patient's quality of life.
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Antunes et al. (2023) conducted a case report in Acute myocardial infarction and intracranial aneurysm (n=1). Combined endovascular approach (percutaneous coronary intervention and cerebral aneurysm embolization) was evaluated on Clinical outcome (survival and absence of complications). A combined endovascular approach successfully treated a 78-year-old woman presenting with both a non-ST elevation myocardial infarction and an unruptured intracranial aneurysm, resulting in discharge without complications.
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