Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?

We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarction (MI)–stroke association, as was evident in our case by an acute inferoposterior and right ventricular STEMI together with massive infarction involving the brain stem, both cerebellar hemispheres and occipital lobes. We labeled this presentation as “cardiocerebral infarction” and provided suggested explanations for this association . We also described the pulmonary embolism (PE)–stroke association in a patient with patent foramen ovale who had a postoperative PE causing shunt reversal and subsequent paradoxical cerebral embolism . Various other scenarios of simultaneous vascular thrombosis have been reported, including simultaneous pulmonary and coronary thrombosis and simultaneous systemic thromboembolism during atrial fibrillation or secondary to left ventricular thrombus . Simultaneous vascular thrombosis can be synchronous (thrombosis of 2...
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Correspondence Source Type: research