Abstract
Background and aims
Cardio-cerebral infarction (CCI), defined as the concomitant or closely occurrence of acute ischemic stroke (AIS) and myocardial infarction (MI), is a rare but life-threatening condition. We report a single-center case series of CCI patients treated with cerebral reperfusion therapies over five years.
Methods
We identified CCI cases among AIS patients treated between 01/01/2020 and 31/12/2025. Clinical, neuroimaging, outcome data were retrospectively collected. A narrative literature review was performed.
Results
CCI occurred in 22/2135 AIS patients (1%), median-aged 68 (IQR 63-83), 60% males. Most patients presented with large/medium vessel occlusions; median NIHSS was 12 (IQR 7-22). 10 patients received intravenous thrombolysis (IVT), 3 thrombectomy (EVT), 9 bridging therapy. MI was synchronous in 73%, STEMI in 27%. Median peak troponin I was 3,6ng/mL (IQR 1,2-251). Reduced ejection fraction was observed in all patients, intra-ventricular thrombus (LVT) was detected by echocardiogram in 3 cases. The 54% underwent percutaneous coronary revascularization (PCI+DES), on average 3 days after stroke onset. In two patients with synchronous STEMI, PCI+DES was performed immediately after EVT, using the same vascular access. Triple therapy (DAPT plus anticoagulantion) was prescribed in 41%. Two cases developed non-fatal symptomatic intracerebral hemorrhage. At 3 months, mRS 0-2 was achieved in 27%.
Conclusions
This single-center case series represents one of the largest reported. CCI is a severe underdiagnosed condition1. International guidelines are limited. Different issues should be discussed, including diagnostic approach in interpreting elevated troponin1 and LVT detection2, defining the timing of cerebral and coronary reperfusion3, and the optimal secondary prevention therapy.
Conflict of interest
nothing to disclose