Case Summary: In less than 400 words, please summarize the case. Briefly describe the case and any particular complexities and/or complications encountered.: A cardiocerebral infarction or a simultaneous acute myocardial infarction and acute ischemic stroke is a rare event with no clear recommendations for proper treatment due to the rarity of the scenario. We report a case of cardiocerebral infarction treated with primary percutaneous coronary intervention (PCI) followed by endovascular treatment (EVT).
An 84-year-old male was transferred from another hospital for decreased mentality with right hemiparesis. He had visited the hospital for chest pain. While waiting for examination, he suddenly collapsed with desaturation and was transferred for proper management. Computed tomography angiography showed left proximal ICA occlusion and the left anterior cerebral artery with the left middle cerebral artery supplied via the anterior communicating artery. Electrocardiography indicated anterior wall ST elevation myocardial infarction (STEMI). Portable echocardiography findings suggested left anterior descending (LAD) artery territory insult. After a discussion with the attending cardiologist, we decided on intervention for STEMI first. After loading dual antiplatelet agents, PCI was done. After the procedure, we did EVT on the left ICA. The first pass effect was achieved by aspiration thrombectomy.
Synchronous myocardial infarction and acute ischemic stroke is rare but may be fatal due to the narrow therapeutic time window. Careful discussion with the expert on cardiac status is essential for this challenging situation.