PMID- 34590206
OWN - NLM
STAT- MEDLINE
DCOM- 20220315
LR  - 20220722
IS  - 1590-3478 (Electronic)
IS  - 1590-1874 (Print)
IS  - 1590-1874 (Linking)
VI  - 43
IP  - 4
DP  - 2022 Apr
TI  - Cardio-cerebral infarction in left MCA strokes: a case series and literature 
      review.
PG  - 2413-2422
LID - 10.1007/s10072-021-05628-x [doi]
AB  - The objective of this manuscript is to describe the challenges of Cardio-Cerebral 
      Infarction (CCI) treatment and to highlight the variable approaches in 
      management. CCI is a rare clinical presentation of simultaneous acute ischemic 
      stroke (AIS) and acute myocardial infarction (AMI) and poses a therapeutic 
      challenge for practitioners. Each disease requires timely intervention to prevent 
      irreversible damage; however, optimal management remains unclear. We describe 
      three cases of CCI. All three patients presented with symptomatic left MCA (M1) 
      occlusion, with ST elevation myocardial infarction (STEMI) and left ventricular 
      apical thrombus. Fibrinolysis and mechanical thrombectomy (MT) were discussed in 
      all cases, but only one patient received alteplase (0.9 mg/kg) and none underwent 
      MT. Percutaneous intervention (PCI) was done in only one case. The two patients 
      that did not receive thrombolysis were treated with modified therapeutic heparin 
      (no bolus), and all received antiplatelet therapy. Ultimately, all three patients 
      passed away. CCI poses a clinical challenge for physicians including (1) optimal 
      strategies to enable swift mechanical reperfusion to both the brain and 
      myocardium; (2) difference in dosage of thrombolytics for AIS versus AMI; (3) 
      risk of symptomatic intracerebral hemorrhage following administration of 
      anticoagulation and/or antiplatelet therapy; and (4) caution with use of 
      thrombolytics in the setting of acute STEMI due to the risk of myocardial 
      rupture. In the absence of high quality evidence and clinical guidelines, 
      treatment of CCI is highly individualized.
CI  - (c) 2021. Fondazione Societa Italiana di Neurologia.
FAU - Ibekwe, Elochukwu
AU  - Ibekwe E
AUID- ORCID: 0000-0002-0339-6384
AD  - Department of Neurology and Neurocritical Care, The Ohio State University, 395 
      West 12th Avenue, 7th Floor, Columbus, OH, 43210, USA. ibek01@osumc.edu.
FAU - Kamdar, Hera A
AU  - Kamdar HA
AD  - Department of Neurology and Neurocritical Care, The Ohio State University, 395 
      West 12th Avenue, 7th Floor, Columbus, OH, 43210, USA.
FAU - Strohm, Tamara
AU  - Strohm T
AD  - Department of Neurology and Neurocritical Care, The Ohio State University, 395 
      West 12th Avenue, 7th Floor, Columbus, OH, 43210, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20210929
PL  - Italy
TA  - Neurol Sci
JT  - Neurological sciences : official journal of the Italian Neurological Society and 
      of the Italian Society of Clinical Neurophysiology
JID - 100959175
SB  - IM
MH  - *Cerebral Infarction/complications/therapy
MH  - Humans
MH  - Ischemic Stroke
MH  - Percutaneous Coronary Intervention
MH  - *Stroke/complications
MH  - Treatment Outcome
PMC - PMC8480750
OTO - NOTNLM
OT  - Acute ischemic stroke
OT  - Alteplase
OT  - Cardio-cerebral infarct
OT  - Cerebral ischemia
OT  - Myocardial infarct
COIS- The authors declare no competing interests.
EDAT- 2021/10/01 06:00
MHDA- 2022/03/16 06:00
PMCR- 2021/09/29
CRDT- 2021/09/30 07:27
PHST- 2021/05/25 00:00 [received]
PHST- 2021/09/23 00:00 [accepted]
PHST- 2021/10/01 06:00 [pubmed]
PHST- 2022/03/16 06:00 [medline]
PHST- 2021/09/30 07:27 [entrez]
PHST- 2021/09/29 00:00 [pmc-release]
AID - 10.1007/s10072-021-05628-x [pii]
AID - 5628 [pii]
AID - 10.1007/s10072-021-05628-x [doi]
PST - ppublish
SO  - Neurol Sci. 2022 Apr;43(4):2413-2422. doi: 10.1007/s10072-021-05628-x. Epub 2021 
      Sep 29.