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On-table acute ischemic stroke during primary PCI-double intra-arterial thrombolysis in a young patient: Uncommon complication and “double-edged sword” management

Stroke is an unusual but possibly devastating complication of cardiac catheterization. We report a case where a patient developed transient hemiplegia secondary to the embolization of a thrombus following thromboaspiration in the setting of acute myocardial infarction. The recent American College of Cardiology/European Society of Cardiology guidelines have classified the routine use of thromboaspiration as a Class III indication, but in some special circumstances with large thrombus burden, can be executed with a caution. Preprocedure identification of the high-risk patient should be performed along with measures to avoid ischemic stroke. If stroke happens, the instant evaluation and intervention of the patient could minimize cerebral damage. Every catheterization laboratory should develop a predefined protocol for the management of periprocedural stroke. We have discussed the management of periprocedural stroke with its review of literature.