Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma

Abstract

Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

Mechanical Endovascular Recanalization in a Patient with Middle Cerebral Artery Occlusion by Tumorous Emboli Originating from Cardiac Myxoma

“…2) Thrombolytic therapy for main cerebral arterial embolic occlusions associated with cardiac myxoma was reported in 12 cases, of which 8 cases were by IV rt-PA, 3,[6][7][8][9][10][11][12] 2 cases by IA rt-PA, 4,5) and 2 cases by Urokinase. 17,18) Out of these 12 cases, the treatment was effective in 8 of them [3][4][5][6]8,10,11,17) and not in 4. 7,9,12,18) Although, the tumorous embolus was suggested not to be indicated for rt-PA treatment, 6) favorable outcomes were reported in some of these cases.…”

“…2) Although some cases were successfully treated by recombinant tissue-plasminogen activator (rt-PA) for acute embolic stroke associated with cardiac myxoma, [3][4][5][6][7][8][9][10][11][12] thrombolytic therapies did not seem to be effective for tumorous type of emboli. Garcia et al 13) treated two cases with cardiac myxoma emboli by mechanical endovascular thrombectomy using Solitaire FR Device (Ev3, Plymouth, Minnesota, USA) and Trevo (Concentric Medical, Mountain View, California, USA).…”

A Case Report of Atrial Myxoma presenting with Cardioembolic Stroke and treated with Intravenous Thrombolytic Therapy

“…Partial success was observed using intra-arterial local thrombolysis but with higher risk of hemorrhage. Intravenous recombinant tissue plasminogen activator showed favorable outcome with less hemorrhagic transformation in some case reports [7]. Mechanical thrombectomy was found to be a very reasonable choice for such patients especially when the embolus is composed mainly of tumor tissue, but it would be difficult to speculate that the patient is having myxoma if he was not previously diagnosed [8].…”

Muerte súbita por embolia cerebral de mixoma de la aurícula izquierda

“…Excepcionalmente los mixomas pueden infectarse y dar una clínica que semeja una endocarditis infecciosa 15,16 . En los últimos años y basado en el hallazgo histopatológico de que muchos mixomas cardiacos se asocian a un trombo superficial, se han tratado los émbolos mediante trombolisis para recuperar la permeabilidad vascular 17,18 .…”