静脉溶栓桥接机械取栓的心房黏液瘤青年卒中一例  

Intravenous thrombolysis bridging mechanical thrombectomy in a young stroke patient with atrial myxoma

作　　者：卫恒 姚晓东 孙雅轩 王晶 高奇英 石春阳 Wei Heng;Yao Xiaodong;Sun Yaxuan;Wang Jing;Gao Qiying;Shi Chunyang(Department of Neurology,People′s Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,China;Department of General Practice,People′s Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,China;Department of Cardiac Surgery,People′s Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,China;Zhangma Branch of Changning Health Center,Xiangning,Linfen 042199,China)

机构地区：[1]山西医科大学附属人民医院神经内科,太原030012 [2]山西医科大学附属人民医院全科医疗科,太原030012 [3]山西医科大学附属人民医院心外科,太原030012 [4]山西省乡宁县昌宁镇卫生院张马分院,临汾042199

出　　处：《中华神经科杂志》2020年第11期938-942,共5页Chinese Journal of Neurology

摘　　要：青年卒中病因多样,以心源性最为多见,但是心脏黏液瘤所致的脑栓塞少见,在时间窗内给予静脉溶栓,治疗效果取决于栓子性质。本例患者为青年女性,急性起病,根据症状、体征及颅脑CT除外出血后,考虑急性缺血性脑卒中并立即给予静脉溶栓,疗效较差,排除禁忌证于发病6 h后桥接机械取栓,栓塞物提示黏液瘤倾向,后于心外科行心房黏液瘤切除,病理提示心房黏液瘤。院外随访患者恢复良好,未再发生栓塞事件。该病例提示对于心房黏液瘤所致的急性缺血性脑卒中,静脉溶栓无效时桥接机械取栓可能是安全有效的,病情平稳后应立即行黏液瘤切除。The causes of stroke in young people are diverse,most of which are cardiogenic.However,cerebral embolism caused by cardiac myxoma is rare.Intravenous thrombolysis is given in the time window,and the therapeutic effect depends on the nature of embolus.This case is a young female patient,with acute onset,excluding bleeding on the basis of the symptoms,signs and craniocerebral CT.After diagnosed as acute ischemic stroke,the patient was performed an immediate intravenous thrombolysis,though the curative effect was poor.Excluding contraindications six hours after onset,bridging mechanical thrombectomy was performed,postoperative embolus biopsy indicating myxoma.Atrial myxoma was removed in cardiac surgery two months later,and the pathology indicated atrial myxoma.The patient recovered well during the out-of-hospital follow-up,and no further embolization occurred.Therefore,it is suggested that bridging mechanical thrombectomy may be safe and effective for acute ischemic stroke caused by atrial myxoma when intravenous thrombolysis is ineffective,and myxoma resection should be performed immediately after the disease is stable.

关 键 词：静脉溶栓 机械取栓 心房黏液瘤 青年卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]