Rao Jie, Tao Zi, Bao Qiongqiong, Jiang Mingxia, Zhou Enyang, 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 May 12;13:893807. doi: 10.3389/fneur.2022.893807. eCollection 2022.
Acute ischemic stroke (AIS) is a major life-threatening consequence of cardiac myxoma (CM) and leads to a poor prognosis. Although intravenous thrombolysis (IVT) is the first-line treatment for AIS, its efficacy and safety in CM-AIS have not been established. Currently, there are only limited data from case reports. Our study aimed to investigate the clinical characteristics of CM-AIS and evaluate the safety and efficacy of IVT for CM-AIS patients.
Fourteen CM-AIS patients who received IVT between January 2016 and December 2021 were identified from our multicenter stroke registry databases. Clinical, neuroimaging and outcome data were analyzed. We then performed a pooled analysis of the published literature from inception to December 2021.
Of the 14 CM-AIS patients, nine were treated with IVT alone, and five were treated with bridging therapy (BT). The median age was 51.5 years, and 57.1% were female. The median onset-to-needle time was 160 min. The median National Institute of Health Stroke Score (NIHSS) decreased from 15.5 at presentation to 13 24 h after IVT. Very early neurological improvement (VENI) was observed in one patient. Hemorrhagic transformation (HT) was observed in five (35.7%) patients, and only one patient was symptomatic (7.1%). Three-month favorable outcomes were achieved in six patients (66.7%) who underwent IVT alone and three patients (60%) who received BT, which resulted in a total proportion of favorable outcomes of 64.3%. None of the patients died at 3 months follow-up. Forty-seven cases (15 BT patients) were included for the pooled analysis. The median NIHSS score was 16.5, and VENI was observed in 10 (21.3%) patients. HT was detected in 11 patients (23.4%), and four (8.5%) patients were symptomatic. Favorable outcomes at 3 months were achieved in 61.7% of patients, 56.3% of patients who underwent IVT alone, and 73.3% of patients who received BT. The 3-month mortality rate was 4.3%.
IVT is a potentially safe and efficient treatment for CM-AIS patients. Further studies with larger sample sizes are required to provide more evidence on the safety and efficacy of IVT and BT in CM-AIS patients.
急性缺血性卒中（AIS）是心脏黏液瘤（CM）的一种主要危及生命的后果，且预后较差。尽管静脉溶栓（IVT）是AIS的一线治疗方法，但其在CM-AIS中的疗效和安全性尚未明确。目前，仅有来自病例报告的有限数据。我们的研究旨在调查CM-AIS的临床特征，并评估IVT对CM-AIS患者的安全性和疗效。
从我们的多中心卒中登记数据库中识别出2016年1月至2021年12月期间接受IVT的14例CM-AIS患者。对临床、神经影像学和结局数据进行分析。然后，我们对从开始到2021年12月发表的文献进行了汇总分析。
在14例CM-AIS患者中，9例仅接受了IVT治疗，5例接受了桥接治疗（BT）。中位年龄为51.5岁，57.1%为女性。中位从发病到穿刺时间为160分钟。静脉溶栓后24小时，美国国立卫生研究院卒中量表（NIHSS）中位数从就诊时的15.5降至13。1例患者出现了极早期神经功能改善（VENI）。5例（35.7%）患者出现了出血转化（HT），只有1例患者出现症状（7.1%）。仅接受IVT治疗的6例患者（66.7%）和接受BT治疗的3例患者（60%）在3个月时获得了良好结局，总体良好结局比例为64.3%。在3个月的随访中，无患者死亡。纳入47例（15例接受BT治疗的患者）进行汇总分析。NIHSS评分中位数为16.5，10例（21.3%）患者出现VENI。11例患者（23.4%）检测到HT，4例（8.5%）患者出现症状。3个月时，61.7%的患者获得了良好结局，仅接受IVT治疗的患者中这一比例为56.3%，接受BT治疗的患者中为73.3%。3个月死亡率为4.3%。
IVT对CM-AIS患者是一种潜在安全且有效的治疗方法。需要更大样本量的进一步研究，以提供更多关于IVT和BT在CM-AIS患者中的安全性和疗效的证据。
