Cardiocerebral Infarction: A Single Institutional Series

Successful endovascular treatment of simultaneous acute ischaemic stroke and hyperacute ST-elevation myocardial infarction: the first case report of a single-operator cardio-cerebral intervention

“…The simultaneous occurrence of cardio-cerebral infarction is a rare clinical entity with a prevalence rate of about 0.25% among the patients admitted for acute myocardial or cerebral infarctions, based on the largest institutional series. 5 The optimal clinical management of these patients is poorly defined, and the overall mortality was found to be larger than 45% at 30 days applying medical therapy or consecutive endovascular interventions provided by separate teams, even though various sequences of the reperfusion therapy (brain–heart vs. heart–brain) were used in these cases. 5 The rapid revascularization of the infarcted territories in the two organs is elementary to avoid death and permanent disability ( Figure 4 ).…”

“… 5 The optimal clinical management of these patients is poorly defined, and the overall mortality was found to be larger than 45% at 30 days applying medical therapy or consecutive endovascular interventions provided by separate teams, even though various sequences of the reperfusion therapy (brain–heart vs. heart–brain) were used in these cases. 5 The rapid revascularization of the infarcted territories in the two organs is elementary to avoid death and permanent disability ( Figure 4 ). The optimal timing of the various components of the anti-thrombotic therapy is also critical, as the obligatory use of antiplatelet medications and anticoagulants in STEMI management can significantly increase the risk for haemorrhagic complications in ischaemic stroke, especially if the blood–brain barrier is compromised by prolonged cerebral ischaemia or by an otherwise minor vascular injury associated with the mechanical recanalization.…”

“…Due to the narrow therapeutic time window and life-threatening natural course of diseases, the mortality rate associated with the cardio-cerebral infarctions is extremely high according to the published case series. 4 , 5 The successfully treated cases may represent a useful learning reference to guide the decision-making in these difficult scenarios. Interventional cardiologists completing the neurointerventional training programme outlined in the latest multi-society consensus document 1 are ideally fit for performing such difficult interventions, as demonstrated by the outcome of the following clinical case.…”

Which one to do first?: a case report of simultaneous acute ischemic stroke and myocardial infarction

“…Despite such important clinical needs, there are no evidence-based guidelines or clinical studies on the management of the co-occurrence of AIS and AMI, especially in the priority of the treatment [7]. Most of the recent studies on CCI are case reports or case series describing various cerebral and myocardial infarct territories, heterogeneous timing and modalities of treatment, and consequent various outcomes [12,13]. Omar et al [5] reported the case of a 48-year-old patient with inferior-posterior and right ventricular AMI concomitant vertebra-basilar territory AIS, who was treated with tPA and conservative management, and expired on the second day of hospital stay.…”

“…Because PCI and EVT are becoming more available these days, the choice of treatment for CCI is becoming more complex. A single-center case series reported that among nine patients who presented with synchronous onset of AMI and AIS, one patient underwent PCI, another patient underwent intravenous thrombolysis, and the others only received conservative management, leaving six survivors [13]. Meanwhile, in a meta-analysis of case reports and series describing the patient characteristics, investigations demonstrated, treatments, and outcomes [14], 10 out of the 44 enrolled patients died within a median of 2 days, despite the aggressive treatment of PCI with stenting in 15 patients, PCI without stenting in eight patients, thrombectomy of a coronary vessel in eight patients, and EVT in 10 patients.…”