Intracranial and visceral arterial embolization of a cardiac myxoma that was treated with endovascular stent-retriever therapy

Abstract

<jats:p> We report a case of a ruptured left atrial myxoma with multiple synchronous sites of embolization, including the intracranial cerebral (left middle cerebral artery (MCA) and basilar), visceral (renal, superior mesenteric artery (SMA)) and peripheral circulatory beds (aorta and lower extremities). This synchronous embolization resulted in a catastrophic neurologic and systemic event. An intracranial stent retriever was used to restore cerebral circulation in the symptomatic left MCA distribution, which resulted in resolution of the acute neurologic deficits. Endovascular and open surgical interventions were later performed to address the residual cardiac mass and other embolic sites. The patient survived the event with the loss of her right leg below the knee and a transient dialysis requirement. The purpose of this case report is to document the successful utilization of a stent-retriever device in removing an embolized myxoma from the cerebral circulation, to review the unique pathology of this source of embolic stroke and to reiterate the importance of considering embolic and non-thrombotic etiologies of acute ischemic stroke, especially in atypical patient populations and patient presentations. </jats:p>

Characterizations of Ischemic Stroke Complications in Cardiac Myxoma Patients at a Single Institution in Eastern China

“…Embolic events may involve the central nervous system, the extremity, visceral, coronary, and pulmonary emboli. [8][9][10][11] Our results also showed the involvement of ischemic stroke, the extremity, coronary, and aorta emboli. Embolic events in atrial myxoma are thought to be secondary to embolization of tumor particles.…”

Giant Left Atrial Myxoma Masquerading as Cough-Syncope Syndrome

“… 33 With the Carney complex, the risk of recurrence of an atrial myxoma is as high as 25%, whereas normal recurrence of the atrial myxoma is generally 1% to 3%. 34 The risk and clinical manifestations of embolization depend on which chamber the atrial myxoma resides. With left atrial myxomas, embolism occurs in 30% to 45% of patients, and usually to the brain or kidneys.…”

“…With right atrial myxomas, embolism occurs in 10% of patients, and these can lead to PE. 1,34 Regardless, left atrial myxoma can cause positional symptoms such as paroxysmal nocturnal dyspnea, typical cardiac murmur such as tumor plop, and can cause sudden cardiac death as the worst scenario. 35 A conglomeration of the aforementioned clinical symptoms and signs should raise a high suspicion for early diagnosis of atrial myxoma.…”

Exertional Syncope in a 38 Years Old Man

“…Carney complex consists of pigmentation in the skin called lentigines, multiple myxomatous tumor in the heart as well as throughout the body 16 and tumors in the multiple endocrine glands . This complex ids responsible for 7% to 10% of cardiac myxoma and recurrence rate is 17,18 high .…”