Successful Endovascular Management of Concomitant Ischemic Stroke, Myocardial Infarction, and Massive Pulmonary Embolism

Background: Ischemic stroke, myocardial infarction (MI), and pulmonary embolism (PE) are emergent conditions which can be treated with catheter-directed therapies. Concomitant management of these conditions with catheter-directed therapy is not well-documented and lacks strong guidelines. Case Summary: A 70-year-old woman presented with stroke symptoms and ST-segment elevation MI. Rapid stroke protocol imaging confirmed ischemic stroke and extensive bilateral PE. To address these conditions rapidly and because of contraindications for systemic thrombolysis, she underwent percutaneous coronary intervention without stenting, stroke thrombectomy, and finally pulmonary thrombectomy. Discussion: This case provides insight into the management of a patient with 3 emergent pathologies with catheter-directed therapy. We also provide reasoning for decisions such as vena cava filter placement and forgoing coronary stent placement. Take-Home Messages: This extreme case highlights the use of catheter-directed therapy for a scenario which lacks clear guidelines. Catheter-directed therapy was successfully used to treat ischemic stroke, MI, and PE in a complex patient, resulting in her full recovery.