AN UNCOMMON CASE OF SIMULTANEOUS ACUTE ISCHEMIC STROKE AND ST- SEGMENT ELEVATION MYOCARDIAL INFARCTION

Background and Aims: Simultaneous acute ischemic stroke (AIS) and acute myocardial infarction is a very rare condition (1–2%), and it is the single strongest predictor of in-hospital mortality. Methods: We report a case of a patient with simultaneous AIS and STsegment elevation myocardial infarction (STEMI). Results: A 60-year-old man was admitted to the Emergency Department 52 minutes after sudden onset of right hemiplegia and aphasia. He was a tobacco smoker, had no previous pathology and did not use medical treatment. At admission, examination showed motor aphasia and right hemiplegia (NIHSS¼15). High-sensitivity troponin T level was significantly elevated, associated to ST-segment elevation in V1-V3 leads. Transthoracic echocardiography showed severe myocardial hypokinesis (EF 30%). AngioCT showed occlusion of proximal M1 segment of left Middle Cerebral Artery (MCA). After multidisciplinary evaluation, we decided not to perform intravenous thrombolysis, due to high risk of pericardial effusion in case of percutaneous transluminal coronary angioplasty (PTCA). The patient underwent cerebral thrombectomy 90 minutes after symptoms onset. Immediately after that, a coronary angiography showed stenosis of Anterior Descending Coronary Artery (ADCA) and of Circumflex Artery (CA), treated with PTCA and stenting, 128 minutes after arrival. Clinical follow-up was excellent (3-month NIHSS and mRS=0).