Anesthetic management of acute embolic stroke following Non-ST-Elevation Myocardial Infarction: a case report

The management of patients with severe coronary artery disease (CAD) and acute heart failure following myocardial infarction presents significant challenges. We report the case of a 66-year-old male who developed an acute embolic stroke, possibly due to a cardiogenic embolism, following coronary angiography and cardiac catheterization for a non-ST-elevation myocardial infarction (NSTEMI). The NSTEMI resulted in ischemic cardiomyopathy and left ventricular dysfunction. During an urgent thrombectomy under general anesthesia, the patient required careful propofol dosing to avoid exacerbating his new-onset heart failure. Vasoactive medications, including norepinephrine, epinephrine, phenylephrine, and dobutamine, were used to maintain hemodynamic stability and support myocardial contractility. A thorough understanding of cardiac perfusion dynamics was crucial for the successful anesthetic management of this complex case. This report highlights the importance of individualized anesthetic approaches and the judicious use of vasoactive agents in patients with severe CAD and acute heart failure.