Mechanical endovascular procedure for the treatment of acute ischemic stroke caused by total detachment of a papillary fibroelastoma

Abstract

Papillary fibroelastomas (PFEs) are rare cardiac tumors. Despite their benign nature, they are associated with a high risk of embolic complications including stroke. Endovascular treatment has been reported as a safe procedure in patients with myxoma, the most common type of primary cardiac tumor. A case of ischemic stroke due to embolization of a PFE successfully treated with a single pass of a retrievable stent is described. A 64-year-old patient with a right middle cerebral artery syndrome was treated with an intravenous and endovascular protocol as a revascularization procedure. Mechanical thrombectomy resulted in total recanalization with clinical improvement. Histological examination of the clot showed pathological features of a typical PFE. The endovascular treatment was safe and effective. With mechanical embolectomy it is possible to obtain and analyze pathological specimens, enabling the diagnosis of uncommon strokes.

A Case of Mechanical Reperfusion Therapy for Cerebral Infarction Induced by Tumor Embolism from Lung Cancer

“…With the recent spread of endovascular treatment, cerebral infarction cases in which embolus removed while the patient was alive was histopathologically diagnosed as tumor embolism have been occasionally reported ( Table 1). [5][6][7][8][9][10][11][12][13][14][15] The causative tumor was benign tumor originated from the heart in many cases (10/13, 76.9%). In contrast, only three cases of tumor embolism caused by tumor not originated from the heart.…”

Papillary fibroelastoma: clinical and echocardiographic features and initial approach in 54 cases

“…In our series, 44% of tumors were mobile (movie clips S2 and S3) and we found no relation between mobility and the presence of symptoms or embolism. It has been confirmed that material embolized to various territories may consist of fragments of the PFE or thrombotic material associated to its papillary fronds …”

Multiple Lambl's excrescences with subvalvular extension, a rare cause of cryptogenic stroke: treated by port-access cardiac surgery

“…These tumours may be an incidental finding1 or can be a rare cause of stroke,2–5 or coronary artery obstruction 6. Histologically, they are composed of a cellular fibroelastic core covered by a layer of endothelial cells, and have to be distinguished from cardiac myxomas7 and fibroelastomas,8 9 of which the latter had been reported to be presented as ischaemic stroke 10 11…”