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Cardio-cerebral infarction in left MCA strokes: a case series and literature review

Elochukwu Ibekwe1, Hera A Kamdar2, Tamara Strohm2

  • 1Department of Neurology and Neurocritical Care, The Ohio State University, 395 West 12th Avenue, 7th Floor, Columbus, OH, 43210, USA. ibek01@osumc.edu.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|September 30, 2021
PubMed

Insights

Cardio-Cerebral Infarction (CCI), a rare simultaneous heart attack and stroke, presents complex treatment challenges. Current management strategies are individualized due to a lack of clear guidelines and evidence, with poor patient outcomes observed.

Area of Science:

  • Cardiology
  • Neurology
  • Critical Care Medicine

Background:

  • Cardio-Cerebral Infarction (CCI) is a rare condition involving simultaneous acute ischemic stroke (AIS) and acute myocardial infarction (AMI).
  • Optimal management of CCI is unclear, posing significant therapeutic challenges for clinicians.
  • Timely intervention is crucial for both conditions to prevent irreversible damage.

Observation:

  • Three cases of CCI involving left MCA (M1) occlusion, STEMI, and left ventricular apical thrombus are presented.
  • Treatment discussions included fibrinolysis and mechanical thrombectomy (MT), but only one patient received alteplase, and none underwent MT.
  • Percutaneous coronary intervention (PCI) was performed in one case; modified heparin and antiplatelet therapy were administered to others.

Findings:

  • All three patients diagnosed with CCI ultimately deceased.
  • Key challenges include optimizing reperfusion strategies for both brain and heart, differing thrombolytic dosages, and risks associated with anticoagulation/antiplatelet therapy.
  • Use of thrombolytics in STEMI requires caution due to potential myocardial rupture risk.

Implications:

  • The absence of high-quality evidence and clinical guidelines necessitates highly individualized treatment approaches for CCI.
  • Further research is needed to establish best practices for managing this complex dual pathology.
  • Improved understanding and guidelines could enhance outcomes for patients presenting with simultaneous stroke and myocardial infarction.

Keywords:
Acute ischemic strokeAlteplaseCardio-cerebral infarctCerebral ischemiaMyocardial infarct

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