title: Effective ADAPT Thrombectomy in a Patient with Acute Stroke due to Cardiac Papillary Elastofibroma: Histological Thrombus Confirmation.
abstract: A 75-year-old man with hypertension and atrial fibrillation was admitted to our emergency room with right-sided hemiplegia and complete aphasia (National Institutes of Health Stroke Scale [NIHSS] score = 18). A noncontrast computed tomography scan showed a slight hypodensity in the left insular region and a bright hyperdense sign in the M1 tract of the left middle cerebral artery (MCA). Angio-CT confirmed an occlusion of the M1 tract of the MCA. Magnetic resonance diffusion-weighted imaging/perfusion-weighted imaging was obtained and revealed a mismatch in the left parietal cortical region. Complete revascularization was achieved by thromboaspiration with the A Direct ASPIRATION first PASS TECHNIQUE (ADAPT) technique. Histological examination of the embolic material revealed its nonthrombotic nature: cardiac embolic papillary elastofibroma (PEF). At discharge, good recovery of right-side hemiplegia was observed. This case report is the second in literature in which a histological confirmed cardiac embolic PEF is reported as a cause of embolic stroke. PEF is a rare but potentially treatable cause of embolic stroke. Understanding the nature of the embolic material would help in choosing the best revascularization approach.
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, Sapienza University of Rome, Rome, Italy. Electronic address: f.biraschi@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Biraschi
authors.affiliation: Department of Radiology, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Diana
authors.affiliation: Department of Oncological, Radiological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alesini
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, Sapienza University of Rome, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Guidetti
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, Sapienza University of Rome, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Peschillo
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005350:Fibroma / Q000150:complications* / Q000473:pathology; D006338:Heart Neoplasms / Q000150:complications* / Q000473:pathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D055420:Perfusion Imaging; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: ADAPT; MR perfusion; Stroke; cardiac embolism; mechanical thrombectomy; papillary elastofibroma; thrombus