Yuki Takakazu, Shimozato Rin, Iijima Akira
Department of Neuroendovascular Treatment, JCHO Tokyo Shinjuku Medical Center.
Rinsho Shinkeigaku. 2020 Dec 26;60(12):846-851. doi: 10.5692/clinicalneurol.cn-001439. Epub 2020 Nov 20.
Patient 1 was a 55-year-old male with cerebral infarction due to obstruction of the left middle cerebral artery during treatment for bacteremia, along with a verruca of infectious endocarditis harvested from endovascular thrombectomy. Patient 2 was a 59-year-old female suffering from cerebral infarction at the terminal branch during intrahepatic cholangiocarcinoma chemotherapy who thereafter developed cerebral infarction again due to obstruction of the left middle cerebral artery, along with a verruca of nonbacterial thrombotic endocarditis (NBTE) harvested from endovascular thrombectomy. In tumor-bearing patients, while NBTE may be more closely related to the development of cerebral infarctions than previously assumed, we also need pay attention to the onset of infectious endocarditis. We need further studies on the effectiveness and safety of thrombolysis therapy and endovascular thrombectomy for cerebral infarctions due to endocarditis in both patients. The harvested emboli may provide clues to the differentiation thereof.
患者1是一名55岁男性,在治疗菌血症期间因左大脑中动脉阻塞发生脑梗死,血管内血栓切除术取出的赘生物为感染性心内膜炎。患者2是一名59岁女性,在肝内胆管癌化疗期间终末支发生脑梗死,随后因左大脑中动脉阻塞再次发生脑梗死,血管内血栓切除术取出的赘生物为非细菌性血栓性心内膜炎(NBTE)。在肿瘤患者中,虽然NBTE可能比以前认为的与脑梗死的发生关系更密切,但我们也需要注意感染性心内膜炎的发病情况。对于这两类患者因心内膜炎导致的脑梗死,我们需要进一步研究溶栓治疗和血管内血栓切除术的有效性和安全性。取出的栓子可能为两者的鉴别提供线索。