静脉溶栓桥接动脉取栓成功治疗左房黏液瘤所致急性脑梗死一例

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report

心房黏液瘤作为心脏最常见的良性肿瘤,常由肿瘤或肿瘤表面血栓引起栓塞,黏液瘤所致脑梗死的治疗目前仍是一个临床和技术挑战。惠州市第三人民医院收治了1例61岁左侧大脑中动脉栓塞的男性患者,NIHSS评分16分,发病1 h后接受静脉溶栓并桥接动脉取栓,取出栓子病理提示黏液瘤,术后没有颅内出血,进一步检查发现了左心房肿瘤,3周后手术切除心脏肿瘤,病理报告为心房黏液瘤。在术后1个月的随访中,患者NIHSS评分为1分,改良Rankin量表评分为0分,术后未再出现栓塞发作。推测对心房黏液瘤所致脑梗死进行静脉溶栓并桥接动脉取栓是安全有效的,而尽早的心房黏液瘤切除能有效避免脑梗死复发。

Myxomas are the most frequent,cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli.The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge.A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou.The initial National Institutes of Health Stroke Scale(NIHSS)score was 16.He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator(rt-PA)one hour after stroke onset.No intracranial hemorrhage developed.Pathological study of embolus showed a myxoma.A cardiac mass was found in the left atrium and removed surgically three weeks after stroke.Pathological study of the tumor showed a myxoma.At the one-month follow-up after excision of myxoma,the NIHSS score was 1 and the modified Rankin scale score was 0.No recurrence of embolism occurred after surgical resection.Endovascular thrombectomy after intravenous rt-PA(bridging therapy)for embolic stroke due to cardiac myxoma is safe and effective,and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.