Treatment of acute traumatic intracranial hemorrhage following post-myocardial infarction cardiac arrest: a case report

Managing acute myocardial infarction (AMI) requiring percutaneous coronary intervention (PCI) in patients with concomitant traumatic brain injury presents a substantial clinical challenge because the risk of ischemic cardiac events after PCI must be balanced against the risk of traumatic intracranial hemorrhage (tICH) expansion.This report describes the successful management of a patient with these concomitant conditions.We report the case of a 67-year-old man who sustained head trauma after sudden cardiac arrest (SCA).After 8 minutes of resuscitation, he was diagnosed with AMI and multiple tICHs, including a right frontal contusion hemorrhage and a right parietal epidural hemorrhage.Coronary angiography revealed 99% stenosis of the left circumflex artery, and PCI with coronary stent placement was successfully performed after preprocedural heparinization.To balance the risk of tICH progression against the risk of stent thrombosis, dual antiplatelet therapy (DAPT) was initially withheld and was started 96 hours after PCI.The patient was discharged on postoperative day 30 with a modified Rankin scale score of 0. No further hemorrhagic progression or ischemic cardiac event occurred after DAPT initiation.This case illustrates the successful management of concomitant AMI and tICH by withholding DAPT immediately after PCI and initiating DAPT 96 hours after PCI.