Atrial myxoma-related embolic stroke: two distinct embolic mechanisms and clinical implications in young adults (a case series).

BACKGROUND

Cardiac myxoma can lead to stroke via two distinct embolic mechanisms: embolism from tumor fragments or thromboembolism from the tumor surface. Pathological confirmation of the embolus is rarely conducted; however, the pathological features of stroke have implications for treatment.

CASE SERIES REPORT: We present two young Chinese patients with acute ischemic stroke subsequent to atrial myxoma, whose stroke was caused via distinct embolic mechanisms. The first patient exhibited isolated basilar artery occlusion due to secondary thrombosis. This patient underwent successful computed tomography(CT)-guided mechanical thrombectomy 11 h after symptom onset. The second patient exhibited the combination of cerebral and peripheral embolism due to direct shedding of tumor emboli and was subjected to sequential endovascular treatment. Both patients achieved complete recanalization and favorable 3-month functional outcomes after tumor resection. These cases highlight phenotypic heterogeneity, differences in embolic mechanisms, and the value of integrated imaging, pathological examination, cardiac assessment, and individualized therapy in atrial myxoma-related stroke.

CONCLUSION

Atrial myxoma-associated strokes involve two distinct mechanisms of embolism that may affect secondary prevention and follow-up strategies. Accurate differentiation relies on the pathological examination of embolic material, which requires coordinated multidisciplinary care to develop personalized treatment.