Skip to content
DraconiticResearch
Search Sources API
197,768 studies31 sourcesUpdated 40 min ago
Peer-reviewedCC BY 4.0JACC Case Reports

Ischemic Stroke as the Presenting Feature of Anterior STEMI Complicated by LV Thrombus and Pseudoaneurysm

  • Ibrahim Hasan1
  • Nebras Hasan1
  • Pierre Sfeir2
  • Noura El Sayegh3
  • Marwan M. Refaat1
  • Ziyad Ghazzal1
  1. 1Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  2. 2Division of Cardiothoracic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
  3. 3Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Read full textDOICite

Abstract

Background: Delayed presentation of anterior ST-segment elevation myocardial infarction (STEMI) increases the risk of thromboembolic and mechanical complications.

Case Summary: We report a 41-year-old man who presented with transient right upper extremity weakness and dysarthria and was found to have electrocardiographic evidence of an old anterior myocardial infarction. He experienced chest pain 3 days earlier without seeking medical attention. Cardiac catheterization revealed thrombotic lesions involving the left anterior descending artery and diagonal bifurcation. Echocardiography demonstrated moderately reduced left ventricular systolic function with a large apical thrombus. Brain magnetic resonance imaging showed a small acute ischemic infarct. He was managed medically with antithrombotics and heart failure therapy. Eight weeks later, regular follow-up imaging revealed severe left ventricular dysfunction, aneurysmal remodeling, and pseudoaneurysm formation, requiring urgent surgical repair.

Discussion: This case highlights the dynamic progression from thromboembolic to mechanical complications following delayed-presentation STEMI and underscores the importance of early recognition, multimodality imaging, and close follow-up.

Take-Home Messages: Delayed-presentation anterior STEMI may first manifest as acute ischemic stroke because of left ventricular thrombus. Close follow-up and multimodality imaging are essential to detect late mechanical complications such as left ventricular pseudoaneurysm.

Related

  1. Intraportal Rupture of a Hepatic Hydatid Cyst Complicated by Arterioportal Fistula and Hepatic Artery Pseudoaneurysm.
    Kawtar Khaissidi, Ismail Chaouche, Hajar Ouazzani +7
    CureusPeer-reviewedCC BYFull textMedical imaging & radiologyEurope PMCPMC
  2. Cholecystocolonic fistula with ruptured cystic artery pseudoaneurysm presenting as massive per rectal bleeding: a case report
    Uttam Chaulagain, Kapil Khanal, Naveen Gautam +5
    Annals of medicine and surgery (2012)Peer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  3. Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage
    Slake Mokrytzki, MBBS, Anne Yan Ting Chua, MBBS, Alison Thompson, MD +2
    JACC: Case ReportsPeer-reviewedCC BY-NC-ND 4.0Full text1 citedCardiovascular medicineDOAJPMC
  4. Incidence of left ventricular thrombus and subclinical cerebral infarction by magnetic resonance imaging 2 weeks after anterior ST-elevation myocardial infarction with impaired left ventricular function and apical akinesis
    Thomas Anderton, Lisa Borg, Moosa Shaikh +7
    European Heart Journal Cardiovascular ImagingPeer-reviewedCC BY 4.0Full textCardiovascular medicinePMC
  5. Delayed Renal Artery Stump Pseudoaneurysm and Arteriovenous Fistula Following Nephrectomy Complicated by Pulmonary Coil Migration: Successful Laparoscopic Management
    Paulina Mizera, Karol Kamil Kłosiński, Joanna Maria Czyżewska +3
    Journal of Clinical MedicinePeer-reviewedCC BY 4.0General medicineCrossref

Cite

BibTeXRIS
BibTeX
@article{hasan2026ischemic,
  title = {{Ischemic Stroke as the Presenting Feature of Anterior STEMI Complicated by LV Thrombus and Pseudoaneurysm}},
  author = {Ibrahim Hasan and Nebras Hasan and Pierre Sfeir and Noura El Sayegh and Marwan M. Refaat and Ziyad Ghazzal},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109929},
  url = {https://doi.org/10.1016/j.jaccas.2026.109929},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Ischemic Stroke as the Presenting Feature of Anterior STEMI Complicated by LV Thrombus and Pseudoaneurysm
AU  - Ibrahim Hasan
AU  - Nebras Hasan
AU  - Pierre Sfeir
AU  - Noura El Sayegh
AU  - Marwan M. Refaat
AU  - Ziyad Ghazzal
PY  - 2026
DA  - 2026/08/20
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109929
UR  - https://doi.org/10.1016/j.jaccas.2026.109929
AB  - Background: Delayed presentation of anterior ST-segment elevation myocardial infarction (STEMI) increases the risk of thromboembolic and mechanical complications.  Case Summary: We report a 41-year-old man who presented with transient right upper extremity weakness and dysarthria and was found to have electrocardiographic evidence of an old anterior myocardial infarction. He experienced chest pain 3 days earlier without seeking medical attention. Cardiac catheterization revealed thrombotic lesions involving the left anterior descending artery and diagonal bifurcation. Echocardiography demonstrated moderately reduced left ventricular systolic function with a large apical thrombus. Brain magnetic resonance imaging showed a small acute ischemic infarct. He was managed medically with antithrombotics and heart failure therapy. Eight weeks later, regular follow-up imaging revealed severe left ventricular dysfunction, aneurysmal remodeling, and pseudoaneurysm formation, requiring urgent surgical repair.  Discussion: This case highlights the dynamic progression from thromboembolic to mechanical complications following delayed-presentation STEMI and underscores the importance of early recognition, multimodality imaging, and close follow-up.  Take-Home Messages: Delayed-presentation anterior STEMI may first manifest as acute ischemic stroke because of left ventricular thrombus. Close follow-up and multimodality imaging are essential to detect late mechanical complications such as left ventricular pseudoaneurysm.
SN  - 2666-0849
ER  -