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Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study
Background: 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 anti...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178925/ https://www.ncbi.nlm.nih.gov/pubmed/30337904 http://dx.doi.org/10.3389/fneur.2018.00823 |
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author | 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. |
author_facet | 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. |
author_sort | Stefanou, Maria-Ioanna |
collection | PubMed |
description | Background: 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. Methods: 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. Results: 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 (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Discussion: 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. |
format | Online Article Text |
id | pubmed-6178925 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-61789252018-10-18 Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study 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. Front Neurol Neurology Background: 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. Methods: 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. Results: 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 (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Discussion: 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. Frontiers Media S.A. 2018-10-03 /pmc/articles/PMC6178925/ /pubmed/30337904 http://dx.doi.org/10.3389/fneur.2018.00823 Text en Copyright © 2018 Stefanou, Rath, Stadler, Richter, Hennersdorf, Lausberg, Lescan, Greulich, Poli, Gawaz, Ziemann and Mengel. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology 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. Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title | Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title_full | Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title_fullStr | Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title_full_unstemmed | Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title_short | Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study |
title_sort | cardiac myxoma and cerebrovascular events: a retrospective cohort study |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178925/ https://www.ncbi.nlm.nih.gov/pubmed/30337904 http://dx.doi.org/10.3389/fneur.2018.00823 |
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