Thrombolytic Treatment of Cardiac Myxoma-Induced Ischemic Stroke: A Review
Giuseppe Lo Giudice,
Primary cardiac tumors are uncommon, with an autopsy frequency of 0.001%-0.28%: 75% of them are benign,
and 50-75% of these are myxomas. Often the first neurological manifestations of a cardiac myxoma include transient
ischemic attacks and ischemic strokes. Although thrombolytic therapy represents the gold standard for acute ischemic
stroke treatment, its safety and effectiveness in stroke patients with myxoma is unknown.
From the analysis of the literature on thrombolysis in ischemic stroke patients with myxoma we report clinical evidence
supporting the use of thrombolytics, and the application of thrombolysis in this setting of patients. 23 previous reports
presented patients with acute ischemic stroke and associated cardiac myxoma treated with thrombolytic therapy: 16
patients were treated with intravenous thrombolysis, 4 patients with intra-arterial thrombolysis and 3 patients were treated
with bridging therapy (intravenous alteplase followed by local mechanical thrombolysis).
Our review showed that the possible risk of major bleeding in these patients resulted in limited and small hemorrhages;
furthermore patients who developed cerebral hemorrhage did not deteriorate clinically: waiting for further confirmation
and additional data from a future register, these observations may suggest that, notwithstanding a possible publication
bias, i.v. thrombolytic therapy may be a safe treatment in these patients.
Keywords: Alteplase, cerebral hemorrhage, ischemic stroke, mechanical thrombectomy, myxoma, thrombolysis.
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