Multiple Intracranial Aneurysms Caused by Myxoma: Case Report and Literature Review

Gai, Shiying; Lv, Nan; Zhang, Qi; Zuo, Qiao; Liu, Jianmin; Huang, Qinghai

doi:10.1016/j.wneu.2019.09.014

Cited by 10 publications

(15 citation statements)

References 37 publications

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“…A recent systematic review of 41 cases with CM-related aneurysms reported that most aneurysms are located on the MCA (92.7%), followed by the ACA (65.9%) and PCA (34.1%). One-quarter of patients had a cerebral hemorrhage due to aneurysm rupture ( 29 ). The rupture rate of CM-related aneurysms is higher than that of general intracranial aneurysms (1–3% annually) ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…One-quarter of patients had a cerebral hemorrhage due to aneurysm rupture ( 29 ). The rupture rate of CM-related aneurysms is higher than that of general intracranial aneurysms (1–3% annually) ( 29 ). However, the majority (68.3%) of cases were managed conservatively, and most had no hemorrhage complications (1/28 patients, 3.6%) or aneurysm enlargement (3/28 patients, 10.7%) during an average follow-up duration of 40 months ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…The rupture rate of CM-related aneurysms is higher than that of general intracranial aneurysms (1–3% annually) ( 29 ). However, the majority (68.3%) of cases were managed conservatively, and most had no hemorrhage complications (1/28 patients, 3.6%) or aneurysm enlargement (3/28 patients, 10.7%) during an average follow-up duration of 40 months ( 29 ). A recent study on 412 AIS patients with unruptured intracranial aneurysms demonstrated that thrombolytic therapy does not increase the risk of ICH or sICH in this cohort ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

et al. 2022

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Background and PurposeAcute ischemic stroke (AIS) is a common and life-threatening complication of patients with cardiac myxoma (CM). The role of the mechanical thrombectomy (MT) technique in CM-AIS patients remains unclear, and no guidelines exist for this population. Therefore, we conducted a case series study of MT in CM-AIS patients to investigate its safety and efficacy via a pooled analysis of published literature.MethodsEleven CM-AIS patients who underwent MT between 2016 and 2021 were screened from multicenter stroke databases. Clinical, procedural, and outcome data were obtained from medical records. A systematic review was conducted to identify additional cases from published studies by searching PubMed and China National Knowledge Infrastructure databases. We then performed a pooled analysis of the published cases.ResultsIn the case series study, most patients were male (81.8%), with a median age of 51 years. All patients had CM located in the left atrium. The rate of successful reperfusion using the first-line thrombectomy technique was 100% with stent retriever (SR) and 66.7% with direct aspiration (DA), which resulted in overall successful reperfusion in 94.1% of all occlusions. The retrieved emboli of the five patients who underwent histopathology examination were identified as myxoma components. Hemorrhagic transformation was observed in five (45.5%) patients, of whom one was symptomatic (9.1%). Three-month favorable functional outcomes were achieved in five (45.5%) patients with a 3-month mortality rate of 18.2%. For the literature review, 35 cases with 51 target vessel occlusions were identified and included in the pooled analysis. The rate of successful reperfusion following first-line thrombectomy did not differ between SR (30 patients, 90.9%) and DA (10 patients, 83.3%). The overall successful reperfusion rate was 91.8% of all occlusions. Three-month favorable functional outcomes were achieved in 21 (60.0%) patients, and the mortality rate was 8.6%.ConclusionsOur findings suggest that MT is not only an effective technique but also a safe option for CM-AIS patients with large vessel occlusion. MT has several advantages for this population, which include a high recanalization rate, low bleeding risk, and the ability to evaluate the source of emboli and the etiology of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

et al. 2022

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“…Thus, CM was initially considered a relative contraindication to IVT. The pathophysiological mechanism underlying myxomatous aneurysms are currently unclear, although commonly accepted theories are the neoplastic process theory and micro-embolic damage theory ( 25 , 26 ). To date, there have only been approximately 60 reported cases of myxomatous aneurysms ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

et al. 2022

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Background and PurposeAcute ischemic stroke (AIS) is a major life-threatening consequence of cardiac myxoma (CM) and leads to a poor prognosis. Although intravenous thrombolysis (IVT) is the first-line treatment for AIS, its efficacy and safety in CM-AIS have not been established. Currently, there are only limited data from case reports. Our study aimed to investigate the clinical characteristics of CM-AIS and evaluate the safety and efficacy of IVT for CM-AIS patients.MethodsFourteen CM-AIS patients who received IVT between January 2016 and December 2021 were identified from our multicenter stroke registry databases. Clinical, neuroimaging and outcome data were analyzed. We then performed a pooled analysis of the published literature from inception to December 2021.ResultsOf the 14 CM-AIS patients, nine were treated with IVT alone, and five were treated with bridging therapy (BT). The median age was 51.5 years, and 57.1% were female. The median onset-to-needle time was 160 min. The median National Institute of Health Stroke Score (NIHSS) decreased from 15.5 at presentation to 13 24 h after IVT. Very early neurological improvement (VENI) was observed in one patient. Hemorrhagic transformation (HT) was observed in five (35.7%) patients, and only one patient was symptomatic (7.1%). Three-month favorable outcomes were achieved in six patients (66.7%) who underwent IVT alone and three patients (60%) who received BT, which resulted in a total proportion of favorable outcomes of 64.3%. None of the patients died at 3 months follow-up. Forty-seven cases (15 BT patients) were included for the pooled analysis. The median NIHSS score was 16.5, and VENI was observed in 10 (21.3%) patients. HT was detected in 11 patients (23.4%), and four (8.5%) patients were symptomatic. Favorable outcomes at 3 months were achieved in 61.7% of patients, 56.3% of patients who underwent IVT alone, and 73.3% of patients who received BT. The 3-month mortality rate was 4.3%.ConclusionsIVT is a potentially safe and efficient treatment for CM-AIS patients. Further studies with larger sample sizes are required to provide more evidence on the safety and efficacy of IVT and BT in CM-AIS patients.

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“…The management of aneurysms secondary to atrial myxoma is uncertain. While conservative management is the preferred choice, other options include microsurgery, clipping, coiling, radiotherapy and chemotherapy [17]. There are no randomised controlled trials to address this issue.…”

Section: Discussionmentioning

confidence: 99%

Late Diagnosis of Multiple Cerebral Aneurysms A Decade after Resection of Cardiac Myxoma

2020

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Cerebral embolism from a cardiac myxoma is a rare cause of ischaemic stroke. These emboli may later lead to the development of cerebral aneurysms. We report a case of delayed presentation of neurological manifestations in form of multiple intracranial aneurysms many years after treatment of a cardiac myxoma. Our patient, a 55-year-old right-handed female with a background history of hypertension, first presented at the age of 45 years with a sudden onset of right hemiplegia. A CT brain scan detected multiple infarcts in the territory of the left middle cerebral artery. Echocardiography revealed a cardiac myxoma for which she underwent immediate total surgical resection. Nearly 10 years after this diagnosis, she presented again with right-sided weakness and left ptosis. CT scan of the brain revealed bilateral acute superior cerebellar infarcts with interval evolution of previously known left cortical infarcts. MRI/MR angiogram showed multiple aneurysms arising from the bilateral middle, left anterior and left posterior cerebral arteries. She was managed conservatively. The management of multiple aneurysms with cardiac myxomas is highly debatable and dependent on the patient’s presentation. This case highlights the importance to follow up on potential late extra-cardiac manifestations of the myxomas despite adequate resection.

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Multiple Intracranial Aneurysms Caused by Myxoma: Case Report and Literature Review

Cited by 10 publications

References 37 publications

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

Mechanical Thrombectomy for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Cardiac Myxoma: A Case Series and Pooled Analysis

Late Diagnosis of Multiple Cerebral Aneurysms A Decade after Resection of Cardiac Myxoma

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