A Rare Coexistence of Simultaneous Cardio-Cerebral Infarction

Abstract

Background: Contemporaneous acute myocardial infarction (AMI) and acute ischemic stroke (AIS), termed cardio-cerebral infarction (CCI), is a rare medical emergency. The effectual management of this situation is exigent since early management of one condition will inevitably delay the other. Case Presentation. A 60-year-old woman presented to our hospital with concurrent AMI of the inferior left ventricular wall, complicated by cardiogenic shock and transient complete heart block, and AIS of more than 4.5 hour duration. The cerebral computerized tomography angiography revealed a right-sided terminal internal carotid artery (ICA) occlusion, and the coronary angiogram depicted double vessel disease with a culprit lesion in the right coronary artery (RCA). The patient underwent mechanical thrombectomy for the ICA occlusion by an interventional neuroradiologist followed by the primary percutaneous coronary intervention of the culprit RCA by the interventional cardiologists in the same setting.

Conclusion: A patient with concurrent AMI and AIS is a challenging situation to treat in the emergency department, and the treatment must be individualized for each patient.

Figure 1

ECG shows ST elevation in inferior leads with first degree heart block.

Figure 2

Cerebral CT angiography showing non-opacification of distal ICA and MCA (arrow).

Figure 3

CT cerebral angiogram shows (a) distal ICA occlusion with non-visualization of M1 MCA, (b) stentriever in situ with left ICA run showing a filling defect in distal ICA proximal M1 MCA (arrow), and (c) complete recanalization of ICA MCA.

Figure 4

CAG showing (a) diffusely diseased RCA with maximum stenosis of 80–90% at the mid part with 100% occlusion of AM, (b) CTO of LAD from the mid part and small caliber Left circumflex artery, and (c) TIMI 3 flow after RCA revascularization.