Acute Embolic Cerebral Infarction and Coronary Artery Embolism in a Patient with Atrial Fibrillation Caused by Similar Thrombi

Tokuda, Kou; Shindo, Seigo; Yamada, Kiyofumi; Shirakawa, Manabu; Uchida, Keiji; Horimatsu, Takahiro; Ishihara, Masaharu; Yoshimura, Shinichi

doi:10.1016/j.jstrokecerebrovasdis.2016.01.055

Cited by 22 publications

(12 citation statements)

References 9 publications

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“…There are several conditions that lead to simultaneous acute cerebral and coronary infarction. Atrial fibrillation has been reported as a cause of simultaneous cardiocerebral infarction due to common source of both cerebral and coronary embolism ( 14 , 15 ). Type-I aortic dissection with dissection flap extending to coronary and common carotid arteries origin had been reported to cause concurrent acute myocardial infarction and acute ischemic stroke ( 16 ).…”

Section: Pathophysiology Of Simultaneous Cardiocerebral Infarctionmentioning

confidence: 99%

Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

2017

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Concurrent acute ischemic stroke and acute myocardial infarction is an uncommon medical emergency condition. The challenge for the physicians regarding the management of this situation is paramount since early management of one condition will inevitably delay the other. We present two illustrative cases of “hyperacute simultaneous cardiocerebral infarction” who presented with simultaneous cardiocerebral infarction and arrived at the hospital within the thrombolytic therapeutic window for acute ischemic stroke of 4.5 h. We propose an algorithm for managing the patient with hyperacute simultaneous cardiocerebral infarction based on hemodynamic status and suggest close cardiac monitoring based on the site of cerebral infarction.

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Section: Pathophysiology Of Simultaneous Cardiocerebral Infarctionmentioning

confidence: 99%

Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

2017

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“…Recommendations or guidelines for the management of CCI remain lacking because of the rarity and variable pathophysiology of this clinical scenario. Among the 12 reported patients with detailed clinical information, no patient received oral anticoagulation prior to the event and 3 patients were newly diagnosed as having atrial fibrillation [1, 7, 10–14]. In our patient, appropriate anticoagulation might have prevented the event of CCI.…”

Section: Discussionmentioning

confidence: 78%

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

et al. 2019

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Background Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.

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“…Although the recommended dosages of IV-tPA differ between cerebral and myocardial ischemia, in 6 previously reported cases of CCI treated with IV-tPA therapy, the dosage of IV-tPA applied was that used for acute ischemic stroke [7] A dilemma exists regarding endovascular therapy: although the occluded cerebral and coronary arteries have to be recanalized as soon as possible in the case of CCI, prioritizing one therapy leads to delays in the other. In previous studies, four patients were treated with both PCI and cerebral thrombectomy [7] [14], with cerebral thrombectomy carried out first in 2 patients. One patient showed severe disturbance of consciousness due to the proximal posterior cerebral artery occlusion [3] and another patient had no abnormal findings on ECG in the emergency room [18].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Abe

Tanaka²,

Yamagami

et al. 2019

Preprint

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Background: Simultaneous cerebral and myocardial infarction is called cardiocerebral infarction (CCI), and is rarely encountered. Because of the narrow time window and complex pathophysiology, CCI is challenging to immediately diagnose and treat. Case presentation: A 73-year-old woman suddenly developed right hemiplegia and severe aphasia. Twelve-lead electrocardiography showed tachycardic atrial fibrillation without any significant ST-T change. Magnetic resonance imaging revealed a proximal middle cerebral artery occlusion. She was immediately treated with alteplase at the dosage approved for ischemic stroke followed by mechanical thrombectomy as bridging therapy, and complete recanalization was achieved. Aphasia improved and she began to complain of chest pain, and reported that she had experienced chest discomfort just prior to right limb weakness. Coronary angiography showed a partial filling defect in the right coronary artery with rapid and adequate distal flow, for which percutaneous coronary intervention was not required. Alteplase was suggested to have effectively resolved the coronary emboli. The occlusions of the cerebral and coronary arteries were assumed to have occurred nearly simultaneously and cardiogenic embolism due to atrial fibrillation was considered as the most likely etiology. Conclusions: As seen in the present case, CCI may benefit from immediate treatment with intravenous tissue plasminogen activator (IV-tPA). Although which of percutaneous coronary intervention or cerebral thrombectomy should be performed first remains unclear, we must decide whether to rescue the brain or heart first in each patient within a limited window of time. This dilemma has recently become evident in this era with mechanical thrombectomy strongly established as an effective intervention for acute ischemic stroke. Close cooperation between stroke physicians and cardiologists is becoming more important.

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Acute Embolic Cerebral Infarction and Coronary Artery Embolism in a Patient with Atrial Fibrillation Caused by Similar Thrombi

Cited by 22 publications

References 9 publications

Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First?

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

Simultaneous cardio-cerebral embolization associated with atrial fibrillation: a case report

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