# A case report of concurrent management of acute myocardial infarction complicated by left ventricular thrombus and ischaemic stroke

## TL;DR

This case report describes the successful treatment of a patient with heart attack, blood clot in the heart, and stroke through a multidisciplinary approach.

## Contribution

The paper highlights a novel multidisciplinary heart–brain team approach for managing complex cases of AMI with LVT and stroke.

## Key findings

- Percutaneous mechanical thrombectomy led to significant neurological recovery in a patient with ischaemic stroke.
- Surgical removal of multiple LV apical thrombi restored left ventricular systolic function.
- A heart–brain team approach is critical for managing complex cases of AMI complicated by stroke.

## Abstract

Left ventricular thrombus (LVT) formation is a serious complication of acute myocardial infarction (AMI) requiring complicated management strategies and collaboration among cardiologists, cardiovascular surgeons, and neurosurgeons.

We present the case of an 83-year-old female patient with AMI. Emergency coronary angiography revealed subtotal occlusion of the proximal left anterior descending artery, and the patient was successfully treated with a drug-eluting stent. The following day, she suddenly developed loss of consciousness, global aphasia, and right hemiplegia. Brain magnetic resonance imaging revealed acute ischaemic cerebral infarction caused by multiple mobile LVT, as demonstrated by echocardiography. After a heart–brain team discussion, we decided to perform percutaneous mechanical thrombectomy. Successful recanalization was achieved with mechanical thrombectomy 2 h after presentation, which resulted in significant neurological recovery. Immediately after the thrombectomy, she was transferred to a cardiovascular surgery centre for surgical removal of multiple LV apical thrombi. Two weeks after the operation, the patient was discharged with the recovery of LV systolic function.

Although AMI complicated by acute stroke caused by LVT remains a clinical challenge, a multidisciplinary approach is critically important for optimal care. Based on an urgent team discussion, we decided to perform endovascular thrombectomy for ischaemic stroke, followed by surgical removal of the LVT, requiring patient transportation to the cardiovascular surgery centre. Given that the heart and brain team-based approach remains confined to large, specialized centres, it might be beneficial to establish a community-based integrated heart–brain team that can address the growing needs of complex patients.