Safe and Effective Intravenous Thrombolysis for Acute Ischemic Stroke Caused by Left Atrial Myxoma

Nagy, Christian; Lévy, Michaël; Mulhearn, Thomas J.; Shapland, Maryam; Sun, Henry; Yuh, David D.; Cheung, Dickson; Chandra-Strobos, Nisha

doi:10.1016/j.jstrokecerebrovasdis.2008.11.012

Cited by 48 publications

(39 citation statements)

References 26 publications

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“…Contrary to some expert opinions, systemic thrombolytic therapy may be safely and effectively used to treat acute ischemic strokes from atrial myxoma especially in young patients with short door-to-needle time [9,10]. Further research in a larger population is necessary to determine the best effective and safe therapy for infarction associated with cardiac myxomas [11,12].…”

Section: Discussionmentioning

confidence: 93%

A Case Report of Atrial Myxoma presenting with Cardioembolic Stroke and treated with Intravenous Thrombolytic Therapy

Ismail¹,

Ss²,

Oy³

2015

Journal of Case Reports and Studies

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IntroductionAtrial myxomas are the commonest cardiac tumors. Despite being benign, embolic phenomenon occurs in approximately 40-50 % of cases either to the brain or elsewhere in the vascular tree. The embolic source may be composed of tumor tissue itself, blood clot or both [1]. AbstractBackground: Cardiac myxomas are a potential source of emboli to the brain and elsewhere in the vascular tree. Myxomas are the most common benign primary cardiac tumor in adults. The commonest location of cardiac myxomas is in the left atrium followed by the right atrium and the remainder develops in the ventricles and rarely in the heart valves. Embolic events occur in approximately 40-50% of patients with myxomas. Crebrovascular strokes secondary to myxomas account for less than 1% of all ischemic strokes but should be considered in the differential diagnosis of patients with stroke in young.

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Section: Discussionmentioning

confidence: 93%

A Case Report of Atrial Myxoma presenting with Cardioembolic Stroke and treated with Intravenous Thrombolytic Therapy

Ismail¹,

Ss²,

Oy³

2015

Journal of Case Reports and Studies

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“…2) Thrombolytic therapy for main cerebral arterial embolic occlusions associated with cardiac myxoma was reported in 12 cases, of which 8 cases were by IV rt-PA, 3,[6][7][8][9][10][11][12] 2 cases by IA rt-PA, 4,5) and 2 cases by Urokinase. 17,18) Out of these 12 cases, the treatment was effective in 8 of them [3][4][5][6]8,10,11,17) and not in 4. 7,9,12,18) Although, the tumorous embolus was suggested not to be indicated for rt-PA treatment, 6) favorable outcomes were reported in some of these cases.…”

Section: Discussionmentioning

confidence: 99%

“…2) Although some cases were successfully treated by recombinant tissue-plasminogen activator (rt-PA) for acute embolic stroke associated with cardiac myxoma, [3][4][5][6][7][8][9][10][11][12] thrombolytic therapies did not seem to be effective for tumorous type of emboli. Garcia et al 13) treated two cases with cardiac myxoma emboli by mechanical endovascular thrombectomy using Solitaire FR Device (Ev3, Plymouth, Minnesota, USA) and Trevo (Concentric Medical, Mountain View, California, USA).…”

Section: Introductionmentioning

confidence: 99%

Mechanical Endovascular Recanalization in a Patient with Middle Cerebral Artery Occlusion by Tumorous Emboli Originating from Cardiac Myxoma

Ryu

Ishikawa

Sato

et al. 2015

NMC Case Report Journal

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“…Type 1 myxomas have an irregular or villous surface and a long stalk and are associated with a higher risk of embolization compared with type 2 myxomas, which have a smooth 11,12 Histologically, >40% of cardiac myxomas have evidence of surface thrombi, an important predictor of embolic potential. 13,14 Despite the proposed mechanism that cerebral infarcts may result from embolization of surface thrombi alone, routine use of anticoagulation is not recommended. There are published reports of perioperative use of vitamin K antagonists and aspirin in patients undergoing surgical resection, but there are few data available to support the use of medical therapy in these patients.…”

Section: Discussionmentioning

confidence: 99%

Now You See It, Now You Don’t?

2015

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Foreword Information about a real patient is presented in stages (boldface type) to an expert (Dr Omid Salehian) who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A 52-year-old woman is referred by her family physician to a general internist's clinic for assessment of a 3-month history of exertional dyspnea. She also reports a nonproductive nocturnal cough, night sweats, and an 18-lb weight loss over the preceding 3 months. The patient denies any history of chest pain, palpitations, presyncope, or syncope.The patient has a history of chronic obstructive pulmonary disease for which she was admitted to hospital 3 times in the last several months. Each time, she received a course of antibiotics and oral glucocorticoids, with no relief of her dyspnea. She reports no prior cardiac history, history of malignancies, or venous thromboembolic disease. Her home medications include salbutamol and tiotropium. She is a current smoker, with a 40-pack-year history, and denies alcohol intake or recreational drug use.Dr Salehian: Exertional dyspnea is a common complaint in patients presenting to emergency departments, general practitioners, internists, respirologists, and cardiologists. It has a very broad differential and could be attributable to a problem with the cardiovascular, respiratory, central nervous, or endocrine system. Furthermore, many patients with neoplastic or autoimmune disorders can present with dyspnea. The presence of constitutional symptoms and weight loss in a middleaged smoker is definitely concerning. Malignancy involving the lung, breast, or gastrointestinal system should be at the top of the differential diagnosis. One must also consider the possibility of hematologic malignancies such as lymphoma. Chronic systemic infections such as subacute bacterial endocarditis should be considered in the differential diagnosis. Collagen vascular disorders such as systemic lupus erythematosus or vasculitides could also have a similar presentation. Patient presentation (continued):On physical examination, she appears cachectic, weighing 51 kg at a height of 148 cm. Her blood pressure is 142/80 mm Hg and heart rate is 104 bpm; she has a regular respiratory rate of 24 breaths per minute and oxygen saturation of 93% on room air. Her temperature is 37.8°C. She is in mild respiratory distress, speaking in short sentences. Jugular venous pressure is 7 cm above the sternal angle with a positive abdominojugular reflux. Her carotid pulse is of normal volume and contour with no audible bruits. The apical impulse is normal in location and size. Auscultation reveals a normal S1 and S2 with a soft diastolic murmur heard best at the apex. No extra heart sounds are audible. There are coarse inspiratory crackles bilaterally at the lung bases. There is no pedal edema, and peripheral pulses are all palpable. There are no rashes, swollen joints, or palpable lymph nodes.On laboratory investigations, her total white blood cell count is 13 500 with 90% neutrophils, ...

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Safe and Effective Intravenous Thrombolysis for Acute Ischemic Stroke Caused by Left Atrial Myxoma

Cited by 48 publications

References 26 publications

A Case Report of Atrial Myxoma presenting with Cardioembolic Stroke and treated with Intravenous Thrombolytic Therapy

A Case Report of Atrial Myxoma presenting with Cardioembolic Stroke and treated with Intravenous Thrombolytic Therapy

Mechanical Endovascular Recanalization in a Patient with Middle Cerebral Artery Occlusion by Tumorous Emboli Originating from Cardiac Myxoma

Now You See It, Now You Don’t?

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