Which one to do first?: a case report of simultaneous acute ischemic stroke and myocardial infarction

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.

Is the mechanism of synchronous cardiocerebral infarction (CCI) different from that of metachronous CCI?

“…For these reasons, the mortality rate associated with acute CCI is high. However, comprehensive studies regarding this condition are lacking [8]. Furthermore, despite the distinct differences in the timing of occurrence between synchronous and metachronous CCI, it remains unclear whether there is a difference in the underlying mechanisms between these two forms of CCI.…”