Mechanical thrombectomy for acute ischemic stroke secondary to left atrial myxoma combined with lower-extremity arterial embolism: a case report.

Abstract

Background: Cardiac myxoma (CM) is the most common primary benign cardiac tumor and is a recognized cause of systemic embolism, particularly ischemic stroke. Although cerebral embolic events are relatively common in patients with CM, the simultaneous occurrence of intracranial and peripheral arterial embolism is exceedingly rare and poses substantial diagnostic and therapeutic challenges.

Case description: A 43-year-old woman presented with sudden loss of consciousness and vomiting. Neurological examination revealed severe deficits, and imaging demonstrated acute infarctions involving the cerebellum and pons secondary to basilar artery occlusion. Because intravenous thrombolysis was contraindicated, emergency mechanical thrombectomy was performed, resulting in complete reperfusion. Following neurological improvement, further examination revealed acute ischemia of the left lower extremity. Vascular imaging confirmed multiple arterial occlusions involving the popliteal and tibial arteries, and successful reperfusion was achieved through a second thrombectomy procedure. Histopathological analysis of the retrieved embolic material demonstrated myxomatous tissue. Subsequent transthoracic echocardiography identified a mobile left atrial mass, and surgical resection was performed. Postoperative pathology confirmed the diagnosis of left atrial myxoma. The patient recovered well after multidisciplinary management and achieved complete neurological recovery without residual disability at the 3-month follow-up.

Conclusions: CM can cause extensive and simultaneous embolization involving both cerebral and peripheral arterial circulations. In patients with CM-related stroke, clinicians should maintain a high index of suspicion for embolic events in other vascular territories and perform comprehensive vascular assessment when appropriate. Mechanical thrombectomy may represent an effective treatment strategy for selected patients, while timely surgical resection of the primary tumor is essential for preventing recurrent embolic events and improving clinical outcomes.