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September 15, 2026European Heart Journal Supplements

Integrated Reperfusion for Simultaneous Stemi and Large–vessel Occlusion: A Case Report

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Why the study?

Simultaneous STEMI and acute ischemic stroke is rare and challenging because both require rapid reperfusion, yet STEMI antithrombotic therapy may increase intracranial bleeding risk.

Population

A 75-year-old woman with simultaneous STEMI and acute ischemic stroke

Design

Case report

Follow-up

24 h

Key result

In a 75-year-old woman with simultaneous anterior STEMI and left MCA occlusion, a 'heart-first' strategy of primary PCI followed by mechanical thrombectomy achieved successful reperfusion.

Authors

DRD RossiVZV ZuardiRMR Magnano

Discussion

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Overview

Supports feasibility of heart-first PCI then thrombectomy in concurrent STEMI-stroke; leaves open optimal sequencing for prospective trials.

Key Points

  • To describe the decision-making and reperfusion sequencing strategy for a patient presenting with concurrent ST-elevation myocardial infarction and acute large-vessel occlusion stroke.
  • Evaluated an unstable 75-year-old female presenting with anterior STEMI and concurrent left MCA M1 occlusion accompanied by acute pulmonary edema and hypotension (NIHSS 12).
  • Implemented a multidisciplinary heart-first strategy prioritizing emergency primary percutaneous coronary intervention of the proximal LAD followed immediately by cerebral mechanical thrombectomy.
  • Primary PCI with a drug-eluting stent achieved TIMI 3 coronary flow and stabilized hemodynamics, elevating blood pressure from 88/58 mmHg to 110/70 mmHg and resolving dyspnea.
  • Subsequent mechanical thrombectomy achieved complete TICI 3 cerebral reperfusion with no hemorrhagic transformation at 24 hours, reducing the NIHSS score from 12 to 5.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 75-year-old woman presenting with simultaneous anterior STEMI and left MCA M1 occlusion.
I
Intervention
A 'heart-first' strategy consisting of immediate coronary angiography and primary PCI with drug-eluting stent (DES), followed by mechanical thrombectomy.
O
Outcome
Reperfusion success (TIMI flow and TICI score) and clinical/neurological improvement at 24 hours.

A 'heart-first' sequential reperfusion strategy (primary PCI followed by mechanical thrombectomy) is feasible and effective for hemodynamically unstable patients presenting with simultaneous STEMI and large-vessel occlusion stroke.

Cite This Study

Rossi et al. (2026) conducted a case report in Simultaneous STEMI and acute ischemic stroke (n=1). Primary PCI followed by mechanical thrombectomy was evaluated. In a 75-year-old woman with simultaneous anterior STEMI and left MCA occlusion, a 'heart-first' strategy of primary PCI followed by mechanical thrombectomy achieved successful reperfusion.

synapsesocial.com/papers/6aa9017deed42882c1fc18f4https://doi.org/10.1093/eurheartjsupp/suag058.365
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