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      • Poster Session : PS 0088 ; Cardiology : Paradoxical Stroke after Complex Coronary Intervention in a Patient with End-Stage Renal Disease

        ( Cheng Wei Liu ),( Jen Kuang Lee ),( Yen Jun Lai ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

        The 75-year-old man underwent percutaneous coronary intervention(PCI) for atherosclerosis coronary artery disease. He had end-staged renal disease with maintenance hemodialysis. Right hemiparesis developed ten hours after the procedure. A computed tomography (CT) of brain demonstrated a hyperdense sucal or cortial lesion in the left frontal lobe (Figure 1). This image fi nding suggested subarachnoid hemorrhage. Dual antiplatelet agents (DAPT) were disrupted transiently. A magnetic resonance imaging (MRI) of brain showed high signal in the left precentral gyrus in diffusion weighted imaging (Figure 2) with corresponding hypointensity in apparent diffusion coeffi ciency imaging (Figure 3), suggestive of an acute infarct. After appropriate treatment for acute ischemic stroke and resuming DAPT immediately, he was discharged uneventfully a week later. Disruption of DAPT signifi cantly increased major cardiovascular events after PCI, especially within 7 days (1). In patients with neurological defi cits after coronary intervention is performed, urgent MRI is necessary to differentiate hemorrhagic strokes from ischemic insults with contrast extravasations from the damaged brainblood barrier. Minimizing window period of DAPT is emphasized in patients with suspicious paradoxical stroke. Reference 1. Mehran R, Baber U, Steg PG, et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 382:1714-22, 2013.

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