CORONARY STENT

Description of Event or Problem

A 78-YEAR-OLD FEMALE ARRIVED TO THE ER (EMERGENCY ROOM) ON (B)(6) 2024 AFTER DEVELOPING SYMPTOMS OF SLURRED SPEECH, LEFT SIDED FACIAL DROOP, AND FALLING AS SHE ATTEMPTED TO PUT HER PANTS ON THAT OCCURRED AT 2200. OF NOTE, A NEW CORONARY STENT WAS PLACED IN THE CIRCUMFLEX ARTERY ONE DAY PRIOR (SEE BELOW FOR DETAILS OF THE STENT THAT WAS PLACED): "THE ATTENTION DIVERTED TO THE CIRCUMFLEX WHICH WAS ENGAGED WITH 6 FRENCH I KARI 3.5 LEFT DUE TO SPASM OF THE RADIAL ARTERY AND USING MULTIPLE WIRES INCLUDING WHISPER EXTRA-SUPPORT BUT WAS EXCHANGED INTO AORTA FLOPPY WIRE AND NARROW TO EXTRA-SUPPORT USING 1.25 BUR WAS 2 PASSES WERE MADE THROUGH THE LESION FOLLOWED BY BALLOON DILATATION OF 2.0 X 12 MM EMERGE AT 12 ATM FOLLOWED BY 3.0 X 12 MM NC EMERGE AT 16 ATM AND THE LESION WAS STENTED WITH A 275 X 12 MM LENGTH SYNERGY STENT DEPLOYED AT 16 ATM MULTIUSE OF THE STENT SHOWED EXCELLENT DEPLOYMENT NO EVIDENCE OF DISSECTION TIMI-3 FLOW DISTALLY" INITIAL CT (COMPUTED TOMOGRAPHY) IMAGING REVEALED ACUTE OCCLUSION OF THE M2 SEGMENT OF THE RIGHT MCA (MIDDLE CEREBRAL ARTERY) WITH ISCHEMIA THROUGHOUT THE ENTIRE RIGHT MCA TERRITORY. 2. CT PERFUSION YIELDS A MISMATCH RATIO ESTIMATED AT 3.9 SUGGESTING THAT MECHANICAL THROMBECTOMY/PERCUTANEOUS INTERVENTION MAY YIELD NET POSITIVE BENEFIT. 3. NO SIGNIFICANT CERVICAL CAROTID/VERTEBRAL ARTERY STENOSIS. 4. SEVERE NONOBSTRUCTIVE CALCIFIC PLAQUE BURDEN THROUGHOUT THE CAVERNOUS ICA (INTERNAL CAROTID ARTERY) BILATERALLY. 5. UNREMARKABLE CONTRAST-ENHANCED HEAD CT. NO CONVINCING MASS EFFECT IN THE RIGHT MCA TERRITORY AT THIS TIME. THE PATIENT WAS DIAGNOSED WITH ACUTE ISCHEMIC STROKE (NIHSS OF 11 AS PER NEUROLOGY). THE PATIENT WAS DEEMED TO BE A CANDIDATE FOR THROMBOLYTIC THERAPY AND WAS TREATED WITH 0.25 MG/KG OF TNKASE (17 MG) GIVEN AT 0000 ON (B)(6) 2024. SHE WAS ALSO TAKEN TO THE CATH LAB FOR MECHANICAL THROMBECTOMY. RIGHT MCA THROMBECTOMY WAS PERFORMED WITH TICI 3 REPERFUSION. ROUTINE IMAGING ON (B)(6) 2024 REVEALED DEVELOPMENT OF A NEWLY SEEN HEMORRHAGE MRI (MAGNETIC RESONANCE IMAGING) OF THE BRAIN WITHOUT CONTRAST ((B)(6) 2024) 1. SMALL AMOUNT OF RIGHT PARIETAL SUBARACHNOID HEMORRHAGE. 2. TINY MULTIPLE FOCI OF HEMORRHAGE IN THE RIGHT TEMPORAL OCCIPITAL PARIETAL REGION. 3. RIGHT MASTOID EFFUSION. DESPITE DEVELOPMENT OF SMALL ICH (INTRACEREBRAL HEMORRHAGE) AND SAH (SUBARACHNOID HEMORRHAGE), THE PATIENT IMPROVED BACK TO HER NORMAL BASELINE AFTER TNK (TENECTEPLASE) AND THROMBECTOMY. SHE WAS DISCHARGED HOME ON (B)(6) 2024. ACUTE ISCHEMIC STROKE.