Mechanical thrombectomy for acute ischemic stroke with simultaneous aorto-iliac occlusion due to cardiac myxoma dislodgement - Case report with review of the literature.

Abstract

Introduction - Cardiac myxomas are the most common cardiac tumors that can present with a spectrum of clinical manifestations. They are an uncommon cause of cerebral stroke, and simultaneous involvement of the aorto-iliac vessels is extremely rare with 8 cases reported in the literature over the past 10 years. We provide a pictorial illustration of the radiological, surgical, and histopathological findings, which differentiates our case from others in the literature. Case presentation - A 41-year-old female was admitted with right side weakness and aphasia (NIHSS score of 15). CT and CT-angiography revealed hyperacute brain ischemia with occlusion of left M1-segment of MiddleCerebral-Artery. The patient was shifted to a thrombectomy-capable center, where the left femoral pulse was found to be absence and the right femoral artery had weak pulsations. Mechanical thrombectomy of left MCA was done. Angiography showed occlusions of the distal abdominal aorta, the bilateral common iliac arteries, the left external iliac artery and the left common femoral artery. Surgical embolectomy of peripheral vessels was done. Pathohistology of clots taken out from the cerebral as well as peripheral vessels revealed cardiac myxoma. Patient had complete recovery of the stroke as well as the lower limb ischemia. Conclusion - Atrial myxoma is a rare cause of cerebral stroke requiring a thorough investigation to reach a diagnosis. Mechanical thrombectomy is a safe and effective method for treatment of such strokes. Important to emphasize the need for a multi-disciplinary team in the management of distal embolization in these cases. Data in the literature with regards to its treatment is limited.