Concurrent Acute Ischemic Stroke and Acute Coronary Syndrome: A Case Report on Sequential Endovascular Intervention and Peri-Procedural Antiplatelet Management with Tirofiban

Cases involving both cerebral infarction due to internal carotid artery occlusion and acute coronary syndrome are clinically rare and challenging to treat. A 50-year-old male patient was admitted to the hospital due to coexistence of internal carotid artery occlusion ischemic stroke and acute coronary syndrome. After coronary angiography and percutaneous coronary intervention (PCI), immediately perform cerebral angiography, followed by right internal carotid artery occlusion balloon dilation and stent formation, intracranial artery thrombectomy, and complete recovery of cerebral blood flow. His condition improved significantly after 15 days, and the weakness of the left limbs and alalia improved a lot. The patient who was followed up for 1 years had stable conditions and was able to take care of himself, with an mRS score of 1. Patients with acute cerebral infarction typically receive rt-PA treatment within 4.5 hours. If head and neck CTA reveals occlusion of a large artery, endovascular therapy can be used as a bridge. The therapeutic sequence of coronary stenting followed by endovascular thrombectomy and carotid artery stenting may have been critical to the patient's favorable clinical outcome. While Antiplatelet aggregation is crucial during the perioperative period of carotid artery stenting or/and coronary stent implantation, its initiation within 24 hours of intravenous thrombolysis must balance efficacy against bleeding risk. Tirofiban represents a potential option during this high-risk period.