Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Cardiac Papillary Fibroelastoma: A Case Report

Abstract

Objective: Reperfusion by endovascular mechanical thrombectomy has been proven effective for patients with acute ischemic stroke. Although most embolization sources are thrombi, other types of clots could also be embolic sources. We report a sporadic case of acute ischemic stroke caused by mobilization of cardiac papillary fibroelastoma (CPF).

Case Presentation: A 79-year-old man presented was hospitalized with chronic heart failure due to disdialysis syndrome. He developed sudden consciousness disturbance and was diagnosed with basilar artery occlusion. Mechanical thrombectomy with only one pass of the Penumbra 5MAX ACE (Penumbra Inc., Alameda, CA, USA) was successful with a direct aspiration first-pass technique. Histopathological examination of the papilla-shaped fragile clot with white granular surface, revealed papillary fibroelastoma. Slight improvement in his clinical symptoms was seen after thrombectomy, but the patient died of deterioration of the disdialysis syndrome. CPF diagnosis was based on the pathological findings of the embolus, not on transesophageal echocardiography (TEE) or open heart surgery due to disdialysis syndrome in our patient. In addition, the presence of cardiac tumor could not be confirmed in the autopsy.

Conclusion: CPF is a rare benign cardiac tumor, which might cause cerebral infarction either directly or through thrombus formed by platelets and fibrin. While mechanical thrombectomy is safe and effective, but histopathological diagnosis of the aspirated clot can be recommended, especially if the appearance of the embolic material is unusual.