A case of successful mechanical thrombectomy for cerebral embolism due to atrial myxoma

Abstract

A 28-year-old man presented with sudden onset disturbance of consciousness. The Glasgow Coma Scale (GCS) was E1V1M2. Magnetic resonance angiography (MRA) showed occlusion in the distal basilar artery. Diffusion-weighted imaging (DWI) revealed early ischemic change in the bilateral cerebellar hemispheres. Echocardiography revealed a pedunculated high-intensity mass in the left atrium. We suspected cerebral embolism due to atrial myxoma. Mechanical thrombectomy was performed using a stent retriever without administration of intravenous tissue plasminogen activator (IV-tPA). The procedure was successful, attaining thrombolysis in cerebral infarction (TICI) Grade 3 recanalization. Resection of a left atrial myxoma was performed at a later date. Pathological examination of the retrieved embolus and resected tumor revealed cerebral embolism caused by atrial myxoma. Cerebral embolism along with myxoma is an embolism caused by a thrombus or a tumor. Mechanical thrombectomy can be recovered in any case. In addition, pathological examination of the embolus can provide important information on the diagnosis and prevention of recurrence. Mechanical thrombectomy may be effective for cerebral embolism caused by cardiac myxoma.