Stefanou Maria-Ioanna, Rath Dominik, Stadler Vera, Richter Hardy, Hennersdorf Florian, Lausberg Henning F, Lescan Mario, Greulich Simon, Poli Sven, Gawaz Meinrad P, Ziemann Ulf, Mengel Annerose M
Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Front Neurol. 2018 Oct 3;9:823. doi: 10.3389/fneur.2018.00823. eCollection 2018.
Cardiac myxoma (CM) is the most frequent, cardiac benign tumor and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed. Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed. 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence ( = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments.
心脏黏液瘤（CM）是最常见的心脏良性肿瘤，与脑血管事件（CVE）风险增加相关。尽管手术切除CM是预防CVE复发的唯一治愈性治疗方法，但最近的报告讨论了在CM相关CVE的高危患者中使用抗血小板或抗凝剂进行保守治疗。对图宾根大学医院2005年至2017年的病例记录进行筛查，以确定CM相关CVE患者。评估临床特征、脑和心脏影像学检查结果、组织学报告、应用的治疗方法和长期神经学结果。确定了52例CM患者，其中13例患有短暂性脑缺血发作、缺血性中风或视网膜缺血，纳入了（据我们所知）最大规模的关于CM相关CVE的回顾性研究报告。在所有确定的患者中，CVE是CM的首发表现；61%的患者发生缺血性中风，23%发生短暂性脑缺血发作，15%发生视网膜缺血。46%的患者在抗血小板或抗凝治疗期间发生CVE，而23%的患者在CM手术切除前的桥接抗栓治疗期间发生复发性CVE。CVE与CM手术之间的时间间隔延长与CVE复发显著相关（ = 0.021）。1例患者接受了静脉溶栓治疗，随后进行了血栓切除术，介入治疗后效果良好，无出血转化迹象。我们的结果表明，对于出现CM相关CVE的患者，抗血小板或抗凝治疗不能替代心脏手术。我们发现复发性CVE患者的CVE与CM手术之间的时间间隔显著延长。因此，我们建议在进行根治性CM切除之前，抗栓治疗的等待或桥接间隔应尽可能缩短。根据我们的数据和文献综述，我们建议对于CM相关CVE患者，静脉溶栓和/或血管内介入治疗可能是安全有效的急性治疗方法。
