Eşzamanlı Anterior Stemı ve Akut Mca Oklüzyonu: Kardiyoserebral İnfarkt Olgusu
Özet
Akut iskemik inme ve ST yükselmeli miyokart enfarktüsünün (STEMI) eş zamanlı görülmesi nadir, ancak mortalitesi yüksek bir tablo olup “kardiyoserebral infarkt” olarak adlandırılır. Bu olguda, sağ orta serebral arter (MCA) oklüzyonuna bağlı akut iskemik inme ile anterior STEMI’nin eş zamanlı geliştiği 69 yaşında bir erkek hasta sunulmaktadır. Nörolojik defisitle başvuran ve takipte hemodinamik instabilite ile anterior STEMI gelişen hastada, hemodinamik durum gözetilerek önce koroner reperfüzyon sağlandı, ardından mekanik trombektomi uygulandı. Koroner girişim ve serebral trombektomi teknik olarak başarıyla tamamlanmış olmasına karşın hasta devam eden hemodinamik instabilite nedeniyle kaybedildi. Olgu, kardiyoserebral infarktta tedavi önceliklendirmesinin hemodinamik duruma göre belirlenmesi gerektiğini ve sürecin multidisipliner bir yaklaşım gerektirdiğini vurgulamaktadır.
The simultaneous occurrence of acute ischemic stroke and ST-elevation myocardial infarction (STEMI) is a rare but highly fatal condition referred to as “cardiocerebral infarction.” We report a 69-year-old male who developed concurrent acute ischemic stroke due to right middle cerebral artery (MCA) occlusion and anterior STEMI. The patient presented with a neurological deficit and subsequently developed hemodynamic instability with anterior STEMI during monitoring. Based on the hemodynamic status, coronary reperfusion was prioritized, followed by mechanical thrombectomy. Although both coronary intervention and cerebral thrombectomy were technically successful, the patient died due to ongoing hemodynamic instability. This case underlines that treatment prioritization in cardiocerebral infarction should be guided by hemodynamic status and requires a multidisciplinary approach.
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