Synchronous Acute Ischemic Stroke and Acute Myocardial Infarction: A Case Report

The synchronous presentation of acute ischemic stroke (AIS) and acute myocardial infarction (AMI), termed concurrent cardiocerebral infarction (CCI), is a rare but fatal condition that poses challenges in diagnosis and management. This case report contributes to the limited literature on the successful management of a patient presenting with CCI while emphasizing the risk-benefit balance in thrombolysis and dual antiplatelet therapy. We report a 51-year-old male who presented to the emergency department with a stroke alert after experiencing right-sided flaccid paralysis and aphasia. National Institute of Health Stroke Scale (NIHSS) score on arrival was 24. An initial CT angiogram of the head confirmed the presence of an occluded left internal carotid artery (ICA) terminus with no flow in the left middle cerebral artery (MCA). Tenecteplase 0.25mg/kg was administered, and the patient subsequently underwent thrombectomy. An EKG after undergoing thrombectomy revealed ST elevations in the anteroseptal leads V1-V4. After the thrombectomy, the patient was transferred to a facility with interventional cardiology, where he underwent percutaneous coronary aspiration thrombectomy with drug-eluting stent placement into the proximal and mid-left anterior descending artery. The patient received 300mg rectal aspirin and IV cangrelor. He was continued on aspirin/clopidogrel dual therapy, and the patient was subsequently discharged and instructed to follow up with a cardiologist. This case report underscores the necessity of a holistic approach to management guidelines for patients presenting with synchronous AIS and AMI due to the potential complications associated with the treatment of either AIS or AMI.