High-risk pulmonary thromboembolism in patients with acute cerebral ischemia: case report case report

Tromboembolismo pulmonar de alto riesgo e isquemia cerebral aguda: presentación de caso

Published 2018-11-19


https://doi.org/10.30554/archmed.18.2.2652.2018
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Vol. 18 No. 2
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Case Report Articles
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Meléndez Flórez, H. J., Rueda Rojas, V. P., Domínguez Ramírez, G. A., Blanco Pertúz, P. M., & Berbeo Flórez, M. I. (2018). High-risk pulmonary thromboembolism in patients with acute cerebral ischemia: case report case report. Archivos De Medicina (Manizales), 18(2), 439-446. https://doi.org/10.30554/archmed.18.2.2652.2018
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https://doi.org/10.30554/archmed.18.2.2652.2018
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Meléndez Flórez, H. J., Rueda Rojas, V. P., Domínguez Ramírez, G. A., Blanco Pertúz, P. M., & Berbeo Flórez, M. I. (2018). High-risk pulmonary thromboembolism in patients with acute cerebral ischemia: case report case report. Archivos De Medicina (Manizales), 18(2), 439-446. https://doi.org/10.30554/archmed.18.2.2652.2018

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Héctor Julio Meléndez Flórez
Viviana Pahola Rueda Rojas
Gustavo Adolfo Domínguez Ramírez
Paola María Blanco Pertúz
Marian Indira Berbeo Flórez
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Héctor Julio Meléndez Flórez,

Médico Especialista en Anestesiología y Reanimación. Especialista en Medicina Crítica y Cuidado Intensivo. Especialista en Docencia Universitaria. Magíster en Epidemiología.

Viviana Pahola Rueda Rojas,

Residente de III año de Anestesiología y Reanimación. Hospital Universitario de Santander.

Gustavo Adolfo Domínguez Ramírez,

Médico interno. Semestre XII. Hospital Universitario de Santander. Universidad del Magdalena. Bucaramanga. Santander. Colombia.

Paola María Blanco Pertúz,

Médico interno. Semestre XII. Hospital Universitario de Santander. Universidad del Magdalena. Bucaramanga. Santander. Colombia.

Marian Indira Berbeo Flórez,

Médico y cirujano. Universidad Industrial de Santander. Bucaramanga. Santander. Colombia.

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Summary

The presence of high risk pulmonary thromboembolism in a patient with an acute cerebral ischemic event, although infrequent, poses a high risk of morbimortality and a challenge in its handling. The Thrombolysis as a first treatment is contraindicated given the risk of high intracranial bleeding. For this reason, it is important to propose alternative reperfusion treatments. We present the case of a 45 years old patient with a clinical picture of a six months follow up of headaches that was diagnosed with an aneurism of the cavernous segment of the internal left carotid artery, subjected to embolization and presenting migration of multiple thrombi  from stent proximal end, with failed thrombolysis and the development of ipsilateral hemispheric ischemia; who later presents high risk pulmonary thromboembolism, handled through thromboaspiration and selective pharmacological thrombolysis guided by a catheter and the implementation of a filter in the inferior vena cava. The selective pharmacological thrombolysis guided by catheter makes up the strategy of reperfusion with the best risk/benefit rate in the context of acute cerebral ischemia and high risk pulmonary thromboembolism. Likewise, it is possible to use other treatments to lower the risk of recurrence, such as venous filters and intermittent pneumatic compression.

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