Stroke and Cardiac Papillary Fibroelastoma: Mechanical Thrombectomy after Thrombolytic Therapy

Abstract

We describe a case of a 34-year-old man with a sudden development of right hemiparesis and aphasia because of infarction of the left middle cerebral artery that was submitted to intravenous (IV) recombinant tissue plasminogen activator and mechanical thrombectomy. Transesophageal echocardiogram showed a small mass on the anterior leaflet of the mitral valve. Cardiac surgery was performed, and histological examination of the removed material was consistent with cardiac papillary fibroelastoma (CPF). Experience in using IV thrombolysis for the treatment of embolic stroke because of CPF is limited. To the best of our knowledge, only 3 patients are reported in literature in whom acute ischemic stroke and associated CPF were treated with thrombolytic therapy. A discussion of the efficacy of IV thrombolysis and the possible superiority of mechanical thrombectomy is included.

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

“…Embolic episodes attributed to PFEs have been described in the coronary arteries, the brain spinal cord, retina lungs, and lower limbs . Intermittent obstruction of a coronary ostium due to a mobile PFE has also been reported .…”

“…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 …”

“…It has been confirmed that material embolized to various territories may consist of fragments of the PFE 32,33 or thrombotic material associated to its papillary fronds. 19,34 The presence of echocardiographic predictors for embolism remains controverted. Tamin et al 7 did not find any feature associated with embolism, while in the meta-analysis by Gowda et al 11 mobility and the aortic location were predictors of embolism and death in asymptomatic patients.…”

Aphasia and reperfusion therapies in hyper-acute settings: A scoping review

“…Core concept two: aphasia as an ongoing symptom post reperfusion therapy Fourteen of the 27 studies, summarised in Table I, discussed aphasia as a persisting symptom following reperfusion therapy. When comparing mobility outcomes to aphasia outcomes, four of these studies have reported that mobility outcomes greatly improve, whereas aphasia appears to remain persistent in isolation, following IV and mechanical reperfusion therapy (Crijnen et al, 2016;Layton et al, 2006;Santos et al, 2014;Tassi et al, 2013).…”