Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review
- Department of Neurosurgery, Suzuka General Hospital, Suzuka, Japan
- Department of Cardiology, Suzuka General Hospital, Suzuka, Japan
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
Hideki Nakajima, Department of Neurosurgery, Suzuka General Hospital, Suzuka, Japan.
DOI:10.25259/SNI_593_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Hideki Nakajima1, Takuro Tsuchiya1, Shigetoshi Shimizu1, Kiyotaka Watanabe2, Tetsuya Kitamura2, Hidenori Suzuki3. Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review. 21-Oct-2022;13:479
How to cite this URL: Hideki Nakajima1, Takuro Tsuchiya1, Shigetoshi Shimizu1, Kiyotaka Watanabe2, Tetsuya Kitamura2, Hidenori Suzuki3. Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review. 21-Oct-2022;13:479. Available from: https://surgicalneurologyint.com/surgicalint-articles/11946/
Background: Cardiocerebral infarction (CCI) is a rare entity that refers to the simultaneous occurrence of acute myocardial infarction and acute ischemic stroke. The management of CCI patients remains unclear.
Case Description: An 86-year-old woman with a medical history of paroxysmal atrial fibrillation presented with a sudden onset of consciousness disturbance and right hemiplegia. Computed tomography of the head revealed no intracranial hemorrhage but the left hyperdense middle cerebral artery sign, associated with ST-segment elevation in II, III, and aVF noted on a routine 12-lead electrocardiogram at admission. The patient was immediately brought to the catheterization laboratory and percutaneous coronary intervention (PCI) was performed first, followed by mechanical thrombectomy, resulting in successful revascularization of the both diseases.
Conclusion: Although the treatment strategy of CCI may depend on the condition of coronary and cerebral ischemia, it may be appropriate to prioritize coronary angiography and PCI if not acute ischemic stroke is critical.
Keywords: Atrial fibrillation, Cardiac embolism, Cardiocerebral infarction, Mechanical thrombectomy, Percutaneous coronary intervention
Cardiocerebral infarction (CCI) is a rare entity described by Omar et al. in 2010, which is defined as the simultaneous occurrence of acute myocardial infarction (AMI) and acute ischemic stroke (AIS).[
An 86-year-old woman was rushed to our hospital because of a sudden onset of disturbance of consciousness and right hemiplegia. The patient had a medical history of hypertension and paroxysmal AF, the latter of which had not been treated with anticoagulants due to her advanced age. On admission, her blood pressure was 112/62 mmHg and similar between the right and left limbs, and an irregular pulse of 55 beats/min was measured. Neurological examinations revealed global aphasia and conjugate eye deviation to the left and right hemiplegia with a score of 30 points according to the National Institutes of Health Stroke Scale (NIHSS). Computed tomography (CT) of the head revealed no intracranial hemorrhage but the left hyperdense middle cerebral artery (MCA) sign [
Percutaneous coronary intervention (PCI) and mechanical thrombectomy (MT). Coronary angiography shows occluded right coronary artery (a) and thrombolysis in myocardial infarction Grade 3 recanalization after PCI (b). Cerebral angiography shows the left M1 occlusion (c) and thrombolysis in cerebral infarction Grade 2b recanalization after MT (d).
The prognosis of CCI patients is unclear, but is presumed to be poor due to both AMI and AIS with high morbidities and mortalities as well as a short treatable time window. De Castillo et al. reported that the overall mortality of CCI was 45% (13/29 cases) and good functional outcome at 30-day post-CCI was 21% (6/29 cases).[
To the best of our knowledge, there have been seven CCI patients including our case reported, who had no malignancy and were treated with both PCI and MT [
As to the treatment of CCI, PCI was performed preceding MT in four patients (Cases 1, 2, 6, and our case):[
Finally, rt-PA was administered in two of the seven patients (Cases 4 and 6).[
CCI is very rare and has complex pathophysiology with poor prognosis. A routine 12-lead ECG is useful for ruling the possibility of concurrent AMI out because CCI patients often have impaired consciousness or aphasia by AIS and, therefore, have difficulty in complaining of chest pain and other symptoms typical of AMI. Although the optimal treatment strategy of CCI is unclear, the findings of coronary angiography may be helpful to decide which should be preceded, PCI or MT, in difficult cases. Although rt-PA administration at a dose of AIS for hyperacute CCI is reasonable, it is noted that a risk of bleeding is increased and that the LVO recanalization rate by rt-PA is not as high.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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