PMC8384536_01
Cardiovascular and neurovascular imaging. Electrocardiogram (A) demonstrating anterolateral STEMI. Coronary angiography demonstrated complete occlusion of the LAD (B; red arrowhead) with partial reconstitution of flow following wiring (C) and restoration of normal flow following stent deployment (D; yellow arrowhead). CT angiography (E) demonstrated complete occlusion of the right ICA (red arrowhead) with luminal narrowing and irregularity of the left ICA consistent with dissection and associated thrombus (red arrow). Subsequent CT angiography showed improvement of the left ICA (F, yellow arrow). MRI demonstrated left frontal and parietal lobar multifocal infarction (G).
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ECG revealed sinus tachycardia, anterior ST elevation, and reciprocal inferior depression (Figure 1). She was given aspirin and intravenous bivalirudin and underwent emergent cardiac catheterization that revealed an acute occlusive thrombus of the proximal left anterior descending (LAD) artery and estimated Fick cardiac index 1.9 L/min/m2 (Figure 1, Table 1). Neurology was consulted and urgent head and neck CT angiography revealed high-grade occlusions of the bilateral internal carotid arteries and stigmata of left middle cerebral artery infarct (Figure 1). Brain MRI confirmed evolving left frontal and parietal lobe infarcts (Figure 1).