TWO ACUTE STEMIS AND TWO ACUTE ISCHEMIC STROKES IN THE SAME PATIENT WITHIN FIVE DAYS--WHAT WENT WRONG?/DVA AKUTNA STEMI I DVA AKUTNA ISHEMIJSKA MOZDANA INFARKTA U PET DANA KOD ISTOG BOLESNIKA - STO JE POSLO KRIVO?

It is not uncommon for patients to suffer from both acute myocardial infarction and acute stroke during the hospitalization. According to some studies, about 12% of the elderly population initially hospitalized for acute ischemic stroke also develop type-1 acute myocardial infarction during the same hospitalization. On the other hand, about 0.9% of patients hospitalized for acute coronary syndrome develop acute stroke during the same hospitalization1. The therapeutic approach to such "overlapping" patients is challenging, especially if we also take into account a high risk of bleeding and/or active bleeding. Therefore, interdisciplinary collaboration between cardiology, neurology and interventional neuroradiology is of key importance. Timely intervention and adequate concomitant drug therapy (primarily antiplatelet and anticoagulant therapy) determine treatment outcomes and long-term results. In our recent clinical work, we treated a patient with a series of acute cardiac and cerebral incidents presenting multiple therapeutic dilemmas, who ultimately had an unfavourable neurological outcome. Key words: STEMI, anaemia, antiplatelet drugs, ischemic stroke, thrombectomy Akutni srcani infarkt i akutni mozdani infarkt nerijetko susrecemo kod istog bolesnika tijekom jedne hospitalizacije. Prema nekim istrazivanjima oko 12% starije populacije koja je inicijalno hospitalizirana radi akutnog ishemijskog mozdanog infarkta tijekom iste hospitalizacije razvije i akutni srcani infarkt tip 1, a oko 0.9% hospitaliziranih radi akutnog koronarnog sindroma u istoj hospitalizaciji razvije akutni mozdani infarkt1. Terapijski pristup takvim "preklapajucim" bolesnicima je izazovan, narocito ako tome svemu dodamo jos visoki rizik od krvarenja i/ili aktivno krvarenje. Suradnja struka--kardiologije, neurologije i intervencijske neuroradiologije od velike je vaznosti. Intervencija u vremenskom prozoru te adekvatna popratna medikamentozna (prvenstveno antiagregacijska i antikoagulantna) terapija definiraju ishod lijecenja i dugorocni rezultat. Nedavno smo u klinickom radu imali bolesnika s nizom akutnih srcanih i mozdanih incidenata, nizom terapijskih dilema i naposljetku nepovoljnim neuroloskim ishodom. Kljucne rijeci: STEMI, anemija, antiagregacijska terapija, ishemijski mozdani infarkt, mehanicka trombektomija