ABSTRACT NUMBER: ESOC2026A1522 SIMULTANEOUS STROKE AND STEMI: NAVIGATING A DUAL EMERGENCY IN THE ABSENCE OF GUIDELINES – A CASE SERIES AND LITERATURE REVIEW

Abstract Background and aims Simultaneous large vessel occlusion (LVO) cerebral stroke and ST-elevation myocardial infarction (STEMI) is an unusual but potentially fatal scenario, posing challenges for acute management. The urgent need to reperfuse both the cerebral and coronary vasculatures complicates decision-making in the absence of guidelines to prioritize interventions. This case series highlights clinical and therapeutic features that may be associated with better outcomes. Methods This descriptive case series reports three patients presenting with clinical and imaging evidence of concomitant LVO and STEMI at a center with interventional neurology and cardiology availability. Clinical presentation, imaging, laboratory markers, and decision-making were reviewed. Imaging included computed tomography, angiography, and electrocardiography. A multidisciplinary team, including emergency medicine, neurology, interventional neuroradiology, interventional cardiology, and critical care, established individualized care plans. A literature review identified prior evidence on management strategies and outcomes. Results Outcomes ranged from meaningful neurological recovery to survival with severe deficits and death. Different outcomes were associated with timing of interventions and intensity of early antithrombotic therapy, rather than procedural sequence alone. Conclusions This dual emergency presents diagnostic and therapeutic challenges, including delayed recognition, intervention sequencing, hemodynamic instability, and balancing the antithrombotic therapy with hemorrhagic risk. Management should be individualized based on hemodynamic stability, infarct severity, and available resources. Published reports demonstrate no consensus regarding optimal management, highlighting key considerations and the need for patient-centered, evidence-based guidelines for these rare, high-risk cases. Conflict of interest Veronica Malabet, MD: nothing to disclose; Juan G. Tejada, MD: nothing to disclose; Simona Ivan, MD: nothing to disclose; Michele Glidden, MSN, RN: nothing to disclose; Marla Doerhing, MD: nothing to disclose; Nancy Glober, MD: nothing to disclose; Kristen Quinn, BSN, RN: nothing to disclose; Kyle Frick, MD: nothing to disclose; Danika Smith, BSN, RN: nothing to disclose; Nicolas Useche, MD: nothing to disclose.