Simultaneous cardiocerebral infarctions: a five-year retrospective case series reviewing natural history
Cheryl Zhiya Chong1, Benjamin Yong-Qiang Tan2, Ching-Hui Sia3
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Insights
Concurrent cardiocerebral infarction (CCI) is a rare condition with high mortality. Initial treatment with intravenous tissue plasminogen activator (IV tPA) followed by endovascular therapy may improve outcomes in CCI patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Concurrent cardiocerebral infarction (CCI) involves simultaneous cerebrovascular and coronary occlusions, presenting a rare but severe clinical challenge.
- Limited literature exists on optimal treatment strategies for CCI, contributing to high mortality rates.
- Understanding CCI's natural history and treatment effects is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the characteristics and treatment outcomes of patients with concurrent cardiocerebral infarction.
- To evaluate the effectiveness of different treatment modalities in managing CCI.
- To identify potential optimal treatment pathways for CCI.
Main Methods:
- A prospective stroke database was utilized to identify ten consecutive CCI patients between 2014 and 2018.
- Data collected included patient demographics, cardiovascular risk factors, occlusion details, admission circumstances, and management strategies.
- Patient records and imaging were reviewed to determine the underlying causes of CCI.
Main Results:
- The study identified an incidence of 0.29% for CCI.
- Patients had a median National Institute of Health Stroke Scale score of 15, with a mean age of 59 years; 90% were male.
- Treatment varied, including intravenous tissue plasminogen activator (IV tPA), endovascular therapy, percutaneous coronary intervention (PCI), or conservative management. Five patients achieved excellent functional outcomes (modified Rankin Scale 0-1) at three months, while three died.
Conclusions:
- CCI is a rare, devastating condition associated with significant morbidity and mortality.
- Treatment strategies significantly impact patient outcomes, highlighting the need for further research into ideal acute and post-reperfusion therapies.
- Intravenous tissue plasminogen activator (IV tPA) followed by subsequent coronary or cerebral endovascular therapy appears to be a preferred initial treatment approach for CCI.
Introduction:
Concurrent cardiocerebral infarction (CCI), a rare condition defined as simultaneous occlusions in the cerebrovascular and coronary vessels, has high mortality but very limited literature on optimum treatment methods. A better understanding of the natural history and effect of treatment would improve patient outcomes.
Methods:
Using our prospective stroke database from 2014 to 2018, ten consecutive patients with CCI were identified (incidence = 0.29%). We recorded patient demographics, cardiovascular risk factors, cardiac and cerebral occlusions, circumstances of admission and management of each patient. Patient notes and imaging findings were reviewed to determine the underlying cause of CCI.
Results:
Median National Institute of Health Stroke Scale score was 15 (range 4-27). Mean patient age was 59 years and 90% were men. Two patients were treated with intravenous tissue plasminogen activator (IV tPA) only and three underwent endovascular treatment in both the cerebral and coronary vessels sequentially. One patient underwent percutaneous coronary intervention (PCI) only and two underwent PCI after IV tPA therapy. Two patients were conservatively treated due to poor premorbid status. At the three-month follow-up, five patients had excellent functional outcomes (modified Rankin Scale 0-1) while three died.
Conclusion:
CCI is a rare but devastating clinical scenario, with high incidence of morbidity and mortality. Treatment strategy can impact patient outcome, and further research is warranted on the ideal acute and post-reperfusion treatments for CCI. In this series, IV tPA at stroke doses appeared to be the preferred initial step for its treatment, with subsequent coronary or cerebral endovascular therapy, if necessary.
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