What is the clinical evidence from this study?

Study design: Case Report. Population: Concomitant cerebrovascular stroke and MINOCA (n=1). Intervention: Anticoagulation with low molecular weight heparin (LMWH).

What does this research mean for the field?

Simultaneous cardioembolic stroke and myocardial infarction with non-obstructive coronary arteries (MINOCA) can occur from a single apical thrombus, necessitating the consideration of embolic mechanisms in patients with concurrent neurological and ischemic symptoms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the diagnostic approach and therapeutic challenges in a patient presenting with simultaneous cardioembolic stroke and myocardial infarction with non-obstructive coronary arteries (MINOCA).

September 15, 2026European Heart Journal SupplementsOpen Access

One Shot, Two Kills: An Apical Thrombus Causing Concomitant Cerebrovascular Stroke and Minoca

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Key result

Anticoagulation manages simultaneous cardioembolic stroke and MINOCA driven by an apical thrombus post-MI.

Why the study?

Simultaneous cardioembolic stroke and MINOCA remain a rarely reported association.

Population

A 41-year-old man with prior anterior MI presenting with sudden left-sided paraesthesia

Design

Case report

Authors

MMM MiloOspedale A. Perrino MRM RellaOspedale A. Perrino ACA De CastroOspedale A. Perrino

Discussion

Member takes

Implication

May inform multimodality imaging in concurrent stroke and MINOCA; leaves open optimal antithrombotic strategies.

Key Points

To describe the diagnostic approach and therapeutic challenges in a patient presenting with simultaneous cardioembolic stroke and myocardial infarction with non-obstructive coronary arteries (MINOCA).
Clinical and laboratory evaluation of a 41-year-old male with a history of anterior myocardial infarction presenting with sudden neurological deficits and elevated cardiac biomarkers.
Multimodality diagnostic assessment combining electrocardiography, transthoracic echocardiography, head CT, brain MRI, cardiac magnetic resonance imaging, and deferred coronary angiography.
Transthoracic echocardiography and brain MRI revealed a 10 mm left ventricular apical thrombus and an acute right occipito-mesial and thalamic infarction, respectively.
Cardiac MRI and deferred coronary angiography confirmed acute basal posterior myocardial infarction with microvascular obstruction alongside non-obstructive coronary vessels, establishing embolic MINOCA without hemorrhagic conversion under heparin therapy.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 41-year-old man with a history of prior anterior MI presenting with sudden left-sided paraesthesia, diagnosed with concomitant cerebrovascular stroke and MINOCA.

Intervention

Adjusted-dose low molecular weight heparin (LMWH) and aspirin

Simultaneous cardioembolic stroke and MINOCA is a rare association that requires careful multimodality imaging and balanced antithrombotic management to avoid haemorrhagic transformation.

Cite This Study

Milo et al. (2026) conducted a case report in Concomitant cerebrovascular stroke and MINOCA (n=1). Anticoagulation with low molecular weight heparin (LMWH) was evaluated. A 41-year-old man with a history of prior anterior MI presented with simultaneous cardioembolic stroke and MINOCA caused by an apical thrombus, managed with anticoagulation.

synapsesocial.com/papers/6aa90187eed42882c1fc19c1 https://doi.org/10.1093/eurheartjsupp/suag058.519

Topics

Percutaneous coronary intervention Chronic total occlusion PCI

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One Shot, Two Kills: An Apical Thrombus Causing Concomitant Cerebrovascular Stroke and Minoca

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

One Shot, Two Kills: An Apical Thrombus Causing Concomitant Cerebrovascular Stroke and Minoca

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider