Rao Jie, Tao Zi, Bao Qiongqiong, Xu Mengbei, Jiang Mingxia, Weng Xiongpeng, Yin Bo, Li Dandong, Li Yan, Cai Xueli, Fu Fangwang
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
Front Neurol. 2022 Apr 18;13:877056. doi: 10.3389/fneur.2022.877056. eCollection 2022.
Acute ischemic stroke (AIS) is a common and life-threatening complication of patients with cardiac myxoma (CM). The role of the mechanical thrombectomy (MT) technique in CM-AIS patients remains unclear, and no guidelines exist for this population. Therefore, we conducted a case series study of MT in CM-AIS patients to investigate its safety and efficacy via a pooled analysis of published literature.
Eleven CM-AIS patients who underwent MT between 2016 and 2021 were screened from multicenter stroke databases. Clinical, procedural, and outcome data were obtained from medical records. A systematic review was conducted to identify additional cases from published studies by searching PubMed and China National Knowledge Infrastructure databases. We then performed a pooled analysis of the published cases.
In the case series study, most patients were male (81.8%), with a median age of 51 years. All patients had CM located in the left atrium. The rate of successful reperfusion using the first-line thrombectomy technique was 100% with stent retriever (SR) and 66.7% with direct aspiration (DA), which resulted in overall successful reperfusion in 94.1% of all occlusions. The retrieved emboli of the five patients who underwent histopathology examination were identified as myxoma components. Hemorrhagic transformation was observed in five (45.5%) patients, of whom one was symptomatic (9.1%). Three-month favorable functional outcomes were achieved in five (45.5%) patients with a 3-month mortality rate of 18.2%. For the literature review, 35 cases with 51 target vessel occlusions were identified and included in the pooled analysis. The rate of successful reperfusion following first-line thrombectomy did not differ between SR (30 patients, 90.9%) and DA (10 patients, 83.3%). The overall successful reperfusion rate was 91.8% of all occlusions. Three-month favorable functional outcomes were achieved in 21 (60.0%) patients, and the mortality rate was 8.6%.
Our findings suggest that MT is not only an effective technique but also a safe option for CM-AIS patients with large vessel occlusion. MT has several advantages for this population, which include a high recanalization rate, low bleeding risk, and the ability to evaluate the source of emboli and the etiology of stroke.
急性缺血性卒中（AIS）是心脏黏液瘤（CM）患者常见且危及生命的并发症。机械取栓（MT）技术在CM-AIS患者中的作用仍不明确，且针对该人群尚无相关指南。因此，我们开展了一项CM-AIS患者MT的病例系列研究，通过对已发表文献的汇总分析来探讨其安全性和有效性。
从多中心卒中数据库中筛选出2016年至2021年间接受MT的11例CM-AIS患者。从病历中获取临床、手术及结局数据。通过检索PubMed和中国知网数据库进行系统综述，以确定已发表研究中的其他病例。然后我们对已发表病例进行汇总分析。
在病例系列研究中，大多数患者为男性（81.8%），中位年龄为51岁。所有患者的CM均位于左心房。使用一线取栓技术的成功再灌注率，支架取栓器（SR）为100%，直接抽吸（DA）为66.7%，这使得所有闭塞病例的总体成功再灌注率达到94.1%。接受组织病理学检查的5例患者取出的栓子被鉴定为黏液瘤成分。5例（45.5%）患者出现出血转化，其中1例有症状（9.1%）。5例（45.5%）患者在3个月时获得良好功能结局，3个月死亡率为18.2%。对于文献综述，共识别出35例51处目标血管闭塞病例并纳入汇总分析。一线取栓后的成功再灌注率在SR组（30例，90.9%）和DA组（10例，83.3%）之间无差异。所有闭塞病例的总体成功再灌注率为91.8%。21例（60.0%）患者在3个月时获得良好功能结局，死亡率为8.6%。
我们的研究结果表明，MT不仅是一种有效的技术，对于有大血管闭塞的CM-AIS患者也是一种安全的选择。MT对该人群有几个优点，包括再通率高、出血风险低，以及能够评估栓子来源和卒中病因。
