[Is a previous neurosurgical intervention a contraindication to fibrinolytic therapy? Description of two cases and review of the literature]. / Un precedente intervento di neurochirurgia è una controindicazione al trattamento fibrinolitico? Descrizione di due casi e revisione della letteratura.

The presence of a cerebral pathology or of previous hemorrhagic cerebrovascular accidents is considered a contraindication to fibrinolytic therapy during acute myocardial infarction due to the elevated risk of intracranial hemorrhage. Lytic therapy reduces early mortality by 25-50% in patients with anterior myocardial infarction, and logistic considerations make primary angioplasty unfeasible in most clinical centers. Present guidelines exclude most patients who are at risk of a hemorrhagic stroke from fibrinolytic therapy, depriving some of them of a cure which has been demonstrated to be effective. Here we describe 2 cases of patients who had previously been treated for cerebral aneurysms and who were later treated with fibrinolytics during the course of an acute myocardial infarction. Based on the observation of these 2 cases and on the data available in the literature, we identified some patients with cerebral aneurysms or cerebral artero-venous malformations, whose pathology, once adequately corrected, cannot be considered an absolute contraindication to lytic therapy in the presence of a large myocardial infarction, when an emergency coronary angioplasty cannot be performed.