1
|
Wang L, Ma L, Ren C, Zhao W, Ji X, Liu Z, Li S. Stroke-heart syndrome: current progress and future outlook. J Neurol 2024; 271:4813-4825. [PMID: 38869825 PMCID: PMC11319391 DOI: 10.1007/s00415-024-12480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
Stroke can lead to cardiac complications such as arrhythmia, myocardial injury, and cardiac dysfunction, collectively termed stroke-heart syndrome (SHS). These cardiac alterations typically peak within 72 h of stroke onset and can have long-term effects on cardiac function. Post-stroke cardiac complications seriously affect prognosis and are the second most frequent cause of death in patients with stroke. Although traditional vascular risk factors contribute to SHS, other potential mechanisms indirectly induced by stroke have also been recognized. Accumulating clinical and experimental evidence has emphasized the role of central autonomic network disorders and inflammation as key pathophysiological mechanisms of SHS. Therefore, an assessment of post-stroke cardiac dysautonomia is necessary. Currently, the development of treatment strategies for SHS is a vital but challenging task. Identifying potential key mediators and signaling pathways of SHS is essential for developing therapeutic targets. Therapies targeting pathophysiological mechanisms may be promising. Remote ischemic conditioning exerts protective effects through humoral, nerve, and immune-inflammatory regulatory mechanisms, potentially preventing the development of SHS. In the future, well-designed trials are required to verify its clinical efficacy. This comprehensive review provides valuable insights for future research.
Collapse
Affiliation(s)
- Lanjing Wang
- Department of Neurology, The People's Hospital of Suzhou New District, Suzhou, 215129, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Linqing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, Suzhou, 215129, China
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
- Clinical Center for Combined Heart and Brain Disease, Capital Medical University, Beijing, 100069, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Sijie Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Emergency, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| |
Collapse
|
2
|
Lee J, Choi WY, Park GT, Park KT, Jeong HB, Won H. Concurrent Acute Ischemic Stroke and Myocardial Infarction Associated With Atrial Fibrillation. JACC Case Rep 2024; 29:102145. [PMID: 38223265 PMCID: PMC10784598 DOI: 10.1016/j.jaccas.2023.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
An 85-year-old man was admitted with dysarthria. Electrocardiography showed atrial fibrillation and prominent ST-segment elevation in V2-V6. Multiple acute cerebral infarctions were observed in brain images. Coronary angiography showed total occlusion of the mid left anterior descending artery. After thrombus aspiration, no atherosclerotic changes were observed on intravascular ultrasound.
Collapse
Affiliation(s)
- Jangwon Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won Yeol Choi
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gyu-Tae Park
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Taek Park
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hae-Bong Jeong
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hoyoun Won
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
de la Torre C, Wagner JS, Xu J. Concurrent Cardio-Cerebral Infarction - A Case Report and Literature Review. Neurohospitalist 2024; 14:74-78. [PMID: 38235036 PMCID: PMC10790613 DOI: 10.1177/19418744231193181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Concurrent cardio-cerebral infarction (CCI) describes the simultaneous occurrence of an acute myocardial infarction and an acute ischemic stroke. It is a rare phenomenon, and no consensus yet exists on how to best treat it. CCI patients present with variable clinical scenarios and complications which makes the establishment of a treatment guideline difficult. We present here a case of a 67-year-old male with concurrent acute ST-elevation myocardial infarction and acute ischemic stroke due to right middle cerebral artery occlusion who was successfully treated with Tenecteplase and mechanical thrombectomy. A literature review was also conducted in search of potential reasonable management strategies of CCI.
Collapse
Affiliation(s)
| | | | - Jindong Xu
- Cone HealthStroke Center, Greensboro, NC, USA
- Guilford Neurologic Research, Greensboro, NC, USA
| |
Collapse
|
4
|
Monin A, Didier R, Leclercq T, Chagué F, Rochette L, Danchin N, Zeller M, Fauchier L, Cochet A, Cottin Y. Coronary artery embolism and acute coronary syndrome: A critical appraisal of existing data. Trends Cardiovasc Med 2024; 34:50-56. [PMID: 35868593 DOI: 10.1016/j.tcm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
The occurrence of coronary artery embolism (CE) has been associated with various clinical conditions, including aortic and mitral prosthetic heart valve implantation, atrial fibrillation (AF), dilated cardiomyopathy, neoplasia, infective endocarditis, atrial septal defect, cardiac tumors, and hypercoagulable states. CE is also a rare cause of myocardial infarction (MI), with a prevalence of about 5%, a figure probably underestimated. The purpose of this article was to determine the current state of knowledge on acute coronary syndrome (ACS) related to CE. We thus performed a comprehensive structured literature search of the MEDLINE database for articles published between 1 January 1990 and 31 December 2021. The diagnosis of CE remains difficult despite the currently used Shibata classification, which is based on major criteria, including angiographic characteristics: globular filling defects, saddle thrombi or multiple filling defects and absence of atherosclerosis in the coronary arteries. Suspected or confirmed CE requires the identification of an etiology. There are only two published series on CE, including about 50 cases each. The three main causes in these series were: 1) atrial fibrillation (73% vs 28.3%), 2) cardiomyopathy (9.4% vs 25%) and 3) malignancy (9.6% vs 15.1%). Finally, 26.3% of the MI patients with CE had no identifiable cause of CE. When anatomically possible, analyzing the thrombus after thrombectomy may help. MI due to CE requires systematic assessment of other locations, i.e. multiple coronary and extracardiac locations. Simultaneous systemic embolization to the brain (67%), limbs (25%), kidneys (25%) or spleen (4%) is frequent, occurring in approximately 25% of CE-related MI. In the setting of acute MI, CE is associated with significant morbidity and mortality. Coronary artery thromboembolism is a rare, non-atherosclerotic, cause of ACS, and prospective studies are needed to evaluate a systematic diagnostic approach and personalized therapeutic strategies.
Collapse
Affiliation(s)
- Antoine Monin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Romain Didier
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Thibault Leclercq
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Frédéric Chagué
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Luc Rochette
- PEC2, EA 7460, University of Burgundy, Dijon, France
| | - Nicolas Danchin
- Department of Cardiology, University Teaching Hospital of Georges Pompidou, Paris, France
| | - Marianne Zeller
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France; PEC2, EA 7460, University of Burgundy, Dijon, France
| | - Laurent Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and François Rabelais University, Tours, France
| | - Alexandre Cochet
- Department of Magnetic Resonance Imaging, University Teaching Hospital of Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, Dijon, France.
| |
Collapse
|
5
|
Narváez Orozco A, Navarro Navajas A, Cardona Buitrago C, Senior-Sánchez JM, Ortiz Uribe JC, Delgado Restrepo JA. Coronary Artery Embolism and Myocardial Infarction, case report. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:45-49. [PMID: 38596603 PMCID: PMC10999311 DOI: 10.47487/apcyccv.v5i1.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024]
Abstract
Coronary embolism (CE) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). The clinical presentation is similar to ACS, and the diagnosis is supported by Shibata criteria. Atrial fibrillation is the main reported etiology in CE cases. Management includes percutaneous intervention with thromboaspiration and anticoagulation. The following case is a description of a patient with acute chest pain and recently diagnosed atrial fibrillation (AF) with a rapid ventricular response, is described. A thrombotic lesion in the distal right coronary artery (RCA) of embolic origin, was documented. Successful mechanical thromboaspiration was performed; intravascular ultrasound (IVUS) showed no thrombus, dissection, or atherosclerotic plaque. CE is an underdiagnosed cause of ACS; diagnosis relies on Shibata criteria, and patients experience worse outcomes in follow-up.
Collapse
Affiliation(s)
- Alejandro Narváez Orozco
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Alberto Navarro Navajas
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Carolina Cardona Buitrago
- Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Universidad de AntioquiaUniversidad de AntioquiaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan M. Senior-Sánchez
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan Camilo Ortiz Uribe
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
| | - Juan Andrés Delgado Restrepo
- Sección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades Cardiovasculares, Universidad de Antioquia. Antioquia, Colombia.Universidad de AntioquiaSección de Cardiología, Departamento de Medicina Interna, Grupo para el Estudio de las Enfermedades CardiovascularesUniversidad de AntioquiaAntioquiaColombia
- Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Antioquia, Colombia.Servicio de Hemodinamia, Unidad Funcional Integrada Cardiopulmonar y Vascular PeriféricaHospital Universitario San Vicente FundaciónAntioquiaColombia
| |
Collapse
|
6
|
Pastore C, White M, Henry M, Filler L. Simultaneous Cardiocerebral Infarction Associated with Postcoital Activity. J Emerg Med 2023; 65:e554-e558. [PMID: 37852811 DOI: 10.1016/j.jemermed.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 08/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Cardiocerebral infarction (CCI) is a rare and life-threatening presentation of simultaneous acute myocardial infarction and acute ischemic stroke that requires prompt recognition and proper treatment. CCI is time sensitive and carries a high mortality rate. There is no standardized treatment algorithm that addresses both conditions simultaneously. CASE REPORT We present a 29-year-old man with simultaneous myocardial infarction and thrombotic stroke after coital activity. He presented to the Emergency Department with left-sided extremity weakness and numbness and radicular left-sided chest pain. He suffered a cardiac arrest during his evaluation and required emergent percutaneous coronary intervention with stent placement. He was resuscitated successfully and had an uncomplicated clinical course, with improved neurologic recovery prior to discharge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: CCI is a rare condition that typically occurs in elderly patients with risk factors for cardiovascular disease. Management is challenging due to the time-sensitive nature of diagnosis and treatment of each condition. Treatment is not standardized, unlike individual evidence-based algorithms for thrombotic stroke and acute myocardial infarction. Risks and benefits for each treatment plan should be weighed and therapy should be directed toward the most immediate life-threatening process. This case would add to the literature surrounding this condition and help guide emergency physicians toward the most optimal treatment strategies for this patient population. This case also raises awareness of the existence of this condition and its potential presence in young, otherwise healthy patients.
Collapse
Affiliation(s)
- Carl Pastore
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Michael White
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; Creighton University School of Medicine (Phoenix) Program - Emergency Medicine, Phoenix, Arizona
| | - Michael Henry
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Levi Filler
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; Creighton University School of Medicine (Phoenix) Program - Emergency Medicine, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| |
Collapse
|
7
|
Desai R, Mondal A, Prasad A, Vyas A, Jain A, Rupareliya C, Shah M, Paul T, Kumar G, Sachdeva R. Concurrent Cardio-Cerebral Infarctions in COVID-19: A Systematic Review of Published Case Reports/Series. Curr Probl Cardiol 2023; 48:101814. [PMID: 37209804 PMCID: PMC10193814 DOI: 10.1016/j.cpcardiol.2023.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Twelve CCI patients were studied with confirmed or suspected COVID-19 infection. The majority of these patients were males (83.3%) with a median age of 55 years from three geographical locations, constituting the Middle East (7), Spain (3), and the USA (1). In 6 patients, IgG/IgM was positive for COVID-19, 4 with high pretest probability and 2 with positive RT-PCR. Type 2 DM, hyperlipidemia, and smoking were the primary risk factors. Right-sided neurological impairments and verbal impairment were the most common symptoms. Our analysis found 8 (66%) synchronous occurrences. In 58.3% of cases, neuroimaging showed left Middle Cerebral Artery (MCA) infarct and 33.3% right. Carotid artery thrombosis (16.6%), tandem occlusion (8.3%), and carotid stenosis (1%) were also reported in imaging. Dual antiplatelet therapy (DAPT) and anticoagulants were conservative therapies (10). Two AMI patients had aspiration thrombectomy, while three AIS patients had intravenous thrombolysis/tissue plasminogen activator (IVT-tPA), 2 had mechanical thrombectomy (MT), and 1 had decompressive craniotomy. Five had COVID-19-positive chest X-rays, whereas 4 were normal. four of 8 STEMI and 3 NSTEMI/UA patients complained chest pain. LV, ICA, and pulmonary embolism were further complications (2). Upon discharge, 7 patients (70%) had residual deficits while 1 patient unfortunately died.
Collapse
Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA
| | | | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA
| | - Chintan Rupareliya
- Department of Vascular Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Manan Shah
- Department of Neurocritical Care, Department of Neurology and Neurosurgery, Medical College of Georgia at Augusta University, Augusta, GA
| | - Timir Paul
- Division of Cardiology, University of Tennessee Health Sciences Center at Nashville, Saint Thomas Heart Institute, Nashville, TN
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
| |
Collapse
|
8
|
Watanabe T, Kobara S, Amisaki R, Yamamoto K. Primary percutaneous coronary intervention for cardio-cerebral infarction: a case report. Front Cardiovasc Med 2023; 10:1165735. [PMID: 37583581 PMCID: PMC10424438 DOI: 10.3389/fcvm.2023.1165735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are the leading causes of death globally. Cardio-cerebral infarction (CCI) is the rare occurrence of AMI and AIS, either simultaneously or one after the other. Treatment recommendations are not clear in case of the occurrence of AMI and AIS simultaneously, especially the strategy of primary percutaneous coronary intervention (PCI). Case presentation We report consecutive seven case series of patients with CCI who underwent primary PCI in our institute. Comorbidities, strategy of primary PCI, and outcomes were investigated. All patients presented with the chief complaints associated with stroke. Atrial fibrillation (AF) was complicated in five of CCI patients, and four of AF patients were not anticoagulated. The major causes of stroke were cardiogenic and/or hemodynamic in this case series. All patients showed total occlusion in the culprit lesion, and six patients had other diseased vessels. Thrombus aspiration was mainly chosen as the reperfusion strategy in PCI. However, only two patients were diagnosed as definitive coronary embolism, and stenting was needed in six patients due to severe atherosclerotic lesion in culprit coronary artery. Final thrombolysis in myocardial infarction (TIMI) 3 flow was achieved only in four patients. Hemorrhagic complications occurred in three patients. Two patients died during in-hospital stay, and most had to be transferred for rehabilitation. Conclusions CCI was a rare but fatal condition in patients who underwent primary PCI. Although CCI was associated with concomitant atrial fibrillation, organic coronary stenosis requiring stenting for revascularization was present in almost all the cases. Given the complexity of coronary artery lesions and high in-hospital mortality, further investigations are needed to determine the optimal treatment strategy.
Collapse
Affiliation(s)
- Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University,Yonago,Japan
| | | | | | | |
Collapse
|
9
|
Nakajima H, Tsuchiya T, Shimizu S, Watanabe K, Kitamura T, Suzuki H. Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review. Surg Neurol Int 2022; 13:479. [PMID: 36324934 PMCID: PMC9609951 DOI: 10.25259/sni_593_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Cardiocerebral infarction (CCI) is a rare entity that refers to the simultaneous occurrence of acute myocardial infarction and acute ischemic stroke. The management of CCI patients remains unclear. Case Description: An 86-year-old woman with a medical history of paroxysmal atrial fibrillation presented with a sudden onset of consciousness disturbance and right hemiplegia. Computed tomography of the head revealed no intracranial hemorrhage but the left hyperdense middle cerebral artery sign, associated with ST-segment elevation in II, III, and aVF noted on a routine 12-lead electrocardiogram at admission. The patient was immediately brought to the catheterization laboratory and percutaneous coronary intervention (PCI) was performed first, followed by mechanical thrombectomy, resulting in successful revascularization of the both diseases. Conclusion: Although the treatment strategy of CCI may depend on the condition of coronary and cerebral ischemia, it may be appropriate to prioritize coronary angiography and PCI if not acute ischemic stroke is critical.
Collapse
Affiliation(s)
- Hideki Nakajima
- Department of Neurosurgery, Suzuka General Hospital, Suzuka, Japan
| | - Takuro Tsuchiya
- Department of Neurosurgery, Suzuka General Hospital, Suzuka, Japan
| | | | | | - Tetsuya Kitamura
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
10
|
Lee K, Park W, Seo KD, Kim H. Which one to do first?: a case report of simultaneous acute ischemic stroke and myocardial infarction. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Although there are common risk factors for acute ischemic stroke and myocardial infarction, simultaneous onset of both diseases is uncommon. Here, we present a case of acute cerebral infarction with concurrent fatal myocardial infarction. Case Report: A 54-year-old man presented with left hemiparesis, gaze preponderance to the right side, and visual and tactile extinction. Computed tomography angiography showed occlusion of the right middle cerebral artery. ST-elevation myocardial infarction was suspected on electrocardiography. After the injection of intravenous tissue plasminogen activator, thrombectomy was attempted first, and the coronary angiogram was planned after recanalization of the cerebral artery. However, thrombectomy was discontinued because of cardiac arrest. Despite extracorporeal membrane oxygenation and emergency percutaneous coronary intervention, the patient died of multiorgan failure.Conclusion: Double primary acute ischemic stroke and myocardial infarction are rare but may be fatal due to the narrow therapeutic time window for both diseases. Careful consideration of the urgency of cardiac status is essential.
Collapse
|
11
|
Nardai S, Vorobcsuk A, Nagy F, Vajda Z. 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. Eur Heart J Case Rep 2021; 5:ytab419. [PMID: 34746640 PMCID: PMC8567068 DOI: 10.1093/ehjcr/ytab419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published endovascular treatment of synchronous heart and brain infarctions delivered by a single operator with excellent clinical outcome.
Case summary
A 67-year-old female patient was directly transported to the emergency room of a comprehensive stroke centre with acute onset global aphasia and right hemiplegia. The onset to admission time exceeded the 4.5-h time window of systemic thrombolysis. Head computed tomography (CT) excluded extensive early extensive brain damage, CT angiography documented left middle cerebral artery occlusion and mechanical thrombectomy was indicated. Extensive anterior ST elevation was detected on the transport monitor while waiting for in-hospital transfer. The two simultaneously evolving pathologies were handled in a single endovascular procedure that took less than 60 min by a dual-trained interventional cardiologist/neurointerventional surgeon. The patient recovered without any major cardiac or neurologic sequela.
Discussion
Interventional cardiologists, professionally trained through a neurointerventional fellowship programme to perform endovascular stroke interventions according to the latest multi-society position paper, could not only complement stroke teams lacking manpower, but their unique experience could also help the patients suffering from the most devastating forms of cardio-cerebral infarctions.
Collapse
Affiliation(s)
- Sándor Nardai
- Semmelweis University, Heart and Vascular Center, Városmajor Street 68, Budapest 1122, Hungary
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
- Corresponding author. Tel: +36 206632722,
| | - András Vorobcsuk
- Department of Cardiology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Zsolt Vajda
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| |
Collapse
|