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Toruno M, Al-Janabi O, Karaman I, Ghozy S, Senol YC, Kobeissi H, Kadirvel R, Ashdown B, Kallmes DF. Mechanical thrombectomy for the treatment of large vessel occlusion due to cancer-related cerebral embolism: A systematic review. Interv Neuroradiol 2024:15910199241230356. [PMID: 38332668 DOI: 10.1177/15910199241230356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Cancer-related cerebral embolism due to direct tumor embolization results in a rare acute ischemic stroke with large vessel occlusion (LVO). Despite the established status of mechanical thrombectomy (MT) in LVO management, its effectiveness and safety remains inadequately explored in this specific patient group. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the Nested Knowledge AutoLit software, encompassing databases like Embase, PubMed, Scopus, and Web of Science, from their inception up to 9 May 2023. RESULTS In the review of 35 studies encompassing 37 cases, mean patient age was 52 years, and 30% were female. Cardiac myxoma (29.7%), cardiac papillary fibroelastoma (16.2%), and squamous cell carcinoma of the lung (8.1%) were the most frequent underlying cancers. The left middle cerebral artery was the most commonly affected occlusion site (24.3%). Of the patients, 67.5% underwent MT alone, while 32.5% received MT combined with intravenous thrombolysis. Successful reperfusion (thrombolysis in cerebral infarction (TICI) 2b-3) was achieved in 89.1% of cases, with 59.4% reaching TICI 3. Functional independence was observed in 29.7% of patients. CONCLUSION While limitations exist, this comprehensive study highlights the potential benefits of MT in a patient group historically excluded from major trials, warranting further investigation.
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Affiliation(s)
| | - Omar Al-Janabi
- Department of Neurology, University of Arizona-Tucson, USA
| | - Irem Karaman
- Bahcesehir University School of Medicine, Istambul, Turkey
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yigit Can Senol
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Boyd Ashdown
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Left Atrial Fibroelastoma as a Cause of Stroke: A Case Report. Medicina (B Aires) 2022; 58:medicina58020182. [PMID: 35208506 PMCID: PMC8879893 DOI: 10.3390/medicina58020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac papillary fibroelastoma is a benign and rare primary tumor of the heart that is most frequently located in the aortic or the mitral valves. Papillary fibroelastoma arising from the left atrium is exceedingly rare, comprising less than 7% of all cardiac papillary fibroelastomas. Tumors in this location could be a source of cardioembolic stroke, often in the anterior circulation of the cerebrum. A 66-year-old female presenting with right hemiparesis, central facial palsy, homonymous hemianopia, and dysarthria received intravenous thrombolysis for stroke without apparent improvement. Magnetic resonance imaging of the brain revealed ischemic infarction in the territories of the left middle and posterior cerebral arteries. A tumor with a maximal diameter of 2.3 cm was disclosed during workup for possible cardioembolic stroke with transthoracic echocardiography and computed tomography of the heart. The clinical course was complicated by stroke-in-evolution and hemorrhagic transformation. The patient underwent left atrial tumor excision and left atrium appendage closure. In-patient stroke rehabilitation programs were also initiated after the conditions stabilized. No clinically significant complications developed after the operation. Neurological functions improved and the patient was able to perform most basic daily living activities with some assistance. An exhaustive search for the cause of cardioembolic stroke is paramount, as management strategies may differ from patients with thrombotic stroke.
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Helliwell H, Desai A, McCole M, Beale A, Ramadurai G, Chandrasekaran B, Yiin GS. The importance of early completion of cardiac investigations after ischaemic stroke: a case and systematic review of reperfusion therapy in stroke due to cardiac fibroelastoma. Clin Med (Lond) 2021; 20:597-599. [PMID: 33199328 DOI: 10.7861/clinmed.2020-0763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Andy Beale
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
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Jones V, Finch E, Copley A. Aphasia and reperfusion therapies in hyper-acute settings: A scoping review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:355-367. [PMID: 29614891 DOI: 10.1080/17549507.2018.1448894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 06/08/2023]
Abstract
Purpose: Reperfusion therapies are medical treatments that restore blood flow either by surgical removal of a blood clot or with medications that dissolve clots. The introduction of reperfusion therapies has the potential to change the presentation of aphasia following acute ischaemic stroke (AIS). This scoping study will explore the relationship between aphasia and reperfusion therapies from a speech-language pathology perspective. Method: A systematic literature search was performed on studies published up until October 2016. Relevant studies that reported on aphasia and reperfusion therapy were assessed for quality and the relationship between the two. Results: Overall, 27 studies were identified, these studies were heterogeneous in nature. Despite speech-language pathologists filling a central role in management of aphasia, only seven of these studies mentioned involvement of speech-language pathologists, with minimal information about the precise nature of the involvement of speech-language pathology services. Conclusion: Based on this scoping review, reperfusion therapy appears to be impacting on the presentation of aphasia. A prospective study into reperfusion therapy and aphasia is required to inform speech-language pathologists on this patient population.
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Affiliation(s)
- Victoria Jones
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
- Centre for Functioning and Health Research, Metro South Health , Brisbane , Australia , and
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
- Centre for Functioning and Health Research, Metro South Health , Brisbane , Australia , and
- Speech Pathology Department, Princess Alexandra Hospital , Brisbane , Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
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Grolla E, Dalla Vestra M, Zoffoli G, D'Ascoli R, Critelli A, Quatrale R, Mangino D, Rigo F. Papillary fibroelastoma, unusual cause of stroke in a young man: a case report. J Cardiothorac Surg 2017; 12:33. [PMID: 28526085 PMCID: PMC5437578 DOI: 10.1186/s13019-017-0592-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Papillary fibroelastoma is the third most common primary benign tumor with an incidence of up to 0.33% in autopsy series; it accounts for approximately 75% of all cardiac valvular tumors. CASE PRESENTATION We describe a rare case of a 28-Year-old man that while playing football, had a sudden onset of neurological deficit: aphasia, right hemiparesis and right facial numbness. Transthoracic echocardiography (TTE) showed a 10x10 mm mass attached to the anterior mitral valve leaflet. The patient was treated surgically for the prevention of further embolic complications. Histologic examination of the resected mass revealed a papillary fibroelastoma. It is the third most frequent primary cardiac tumor, after myxoma and fibroma, and the most common primary tumor of heart valves. Despite the benign nature of this tumor, it carries very high risk of embolic complications. The successful complete resection of the papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent. CONCLUSIONS Differential diagnosis of cardiac masses requires clinical informations, laboratory tests, blood cultures and appropriate use of imaging modalities. Papillary fibroelastoma is a potential cause of embolic stroke in the young. The prompt surgical excision of papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent.
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Affiliation(s)
- Elisabetta Grolla
- Department of Cardiology, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Michele Dalla Vestra
- Department of Internal Medicine, Angiology Unit, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Giampaolo Zoffoli
- Department of Cardiac Surgery, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Riccardo D'Ascoli
- Department of Cardiac Surgery, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Adriana Critelli
- Department of Neurology, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Rocco Quatrale
- Department of Neurology, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Domenico Mangino
- Department of Cardiac Surgery, Ospedale dell'Angelo, Venezia-Mestre, Italy.
| | - Fausto Rigo
- Department of Cardiology, Ospedale dell'Angelo, Venezia-Mestre, Italy
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Biraschi F, Diana F, Alesini F, Guidetti G, Peschillo S. Effective ADAPT Thrombectomy in a Patient with Acute Stroke due to Cardiac Papillary Elastofibroma: Histological Thrombus Confirmation. J Stroke Cerebrovasc Dis 2016; 25:e185-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/12/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022] Open
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Cianciulli TF, Soumoulou JB, Lax JA, Saccheri MC, Cozzarin A, Beck MA, Ferreiro DE, Prezioso HA. Papillary fibroelastoma: clinical and echocardiographic features and initial approach in 54 cases. Echocardiography 2016; 33:1811-1817. [PMID: 27566126 DOI: 10.1111/echo.13351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Papillary fibroelastoma (PFE) is a benign cardiac tumor that is currently detected more often due to the technological improvements in echocardiography. OBJECTIVES To describe the echocardiographic features of PFE and correlate them with the clinical presentation and initial treatment. MATERIALS AND METHODS A prospective analysis of patients with a diagnosis of PFE was conducted between 2000 and 2015. We assessed the clinical history, symptoms at the time of diagnosis, echocardiographic features, and initial treatment. RESULTS Fifty-four patients with a diagnosis of PFE by echocardiography were included. The incidence was 0.038%. Mean age was 62±16 years; 50% were male. Forty-six percent of patients had symptoms at the time of diagnosis, the most frequent of which was transient ischemic accident (TIA). Embolic episodes occurred in 31% of patients, mainly to the brain. PFEs were valvular in 70.4% of cases and multiple in 13%. Mean maximum length was 1.18±0.58 cm, and 44% were mobile. PFEs >1.5 cm were most often found in the heart valves (56.8% vs 10.8%; P=.045). There was no significant relation between size, mobility, location and number of tumors, and the presence of embolism or symptoms. Most frequent treatment was oral anticoagulation in 48.6%, followed by simple tumor resection in 42.8% of cases. CONCLUSIONS PFE is a small tumor, predominantly valvular and benign, but entails a high incidence of cerebral embolism. The initial approach should be individualized according to clinical manifestations, comorbidities, and the experience of the surgical center.
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Affiliation(s)
- Tomás Francisco Cianciulli
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Juan Bautista Soumoulou
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Jorge Alberto Lax
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - María Cristina Saccheri
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Alberto Cozzarin
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Martín Alejandro Beck
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Daniel Ernesto Ferreiro
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
| | - Horacio Alberto Prezioso
- Echocardiography Laboratory, Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich,", Buenos Aires, Argentina
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Pathological evidence of cardiac papillary fibroelastoma in a retrieved intracranial embolus. Can J Neurol Sci 2014; 42:66-8. [PMID: 25401516 DOI: 10.1017/cjn.2014.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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