Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7572-7578
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7572
Thrombolysis and embolectomy in treatment of acute stroke as a bridge to open-heart resection of giant cardiac myxoma: A case report
Wan-Sheng Chang, Na Li, Hui Liu, Ji-Jun Yin, Hai-Qi Zhang
Wan-Sheng Chang, Na Li, Hui Liu, Ji-Jun Yin, Hai-Qi Zhang, Department of Neurology, The Second People's Hospital of Liaocheng City, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing 252600, Shandong Province, China
Author contributions: Chang WS and Zhang HQ were the patient’s neurologists; Chang WS, Zhang HQ, Li N, and Liu H reviewed the literature; Chang WS, Zhang HQ, Li N, Liu H, and Yin JJ contributed to manuscript drafting; Chang WS, Zhang HQ, and Yin JJ were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest for this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016)
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Qi Zhang, MD, Doctor, Department of Neurology, The Second People's Hospital of Liaocheng City, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, No. 1 Huamei Road, Linqing 252600, Shandong Province, China. haiqi0603@163.com
Received: March 31, 2021
Peer-review started: March 31, 2021
First decision: May 11, 2021
Revised: May 24, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: September 6, 2021
Abstract
BACKGROUND

Cardiac embolism is a common cause of ischemic stroke in young adults. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Early complete resection of giant cardiac myxoma is the key to its treatment and prevention of stroke recurrence.

CASE SUMMARY

A 42-year-old, previously healthy woman was admitted to the hospital with sudden-onset inability to speak and right-sided hemiplegia. While sweeping the floor 2 h prior to hospital admission, the patient developed sudden inability to express herself or understand what others were saying, accompanied by dyskinesia of the right limb, inability to walk or hold objects, and involuntary choreiform movements of the left upper limb. The patient was diagnosed with cerebral embolism and cardiac myxoma, complicated by left middle cerebral artery occlusion. The acute stroke was treated with intravenous thrombolytic therapy and arterial embolectomy as a bridging therapy to open resection of left atrial cardiac myxoma. The patient condition improved remarkably following initial thrombolysis and embolectomy and subsequently underwent emergency open resection of the atrial cardiac myxoma. She had no recurrence during 1-year follow-up.

CONCLUSION

Strong consideration should be given to urgent intravenous thrombolysis (rt-PA, alteplase) in young adult stroke patients at the time of hospital admission. The present case demonstrated a highly successful outcome that combined thrombolysis and arterial embolus retrieval as a bridge to early complete resection of a giant cardiac myxoma for both stroke treatment and recurrence prevention.

Keywords: Stroke, Young women, Cardiac myxoma, Bridging, Open-heart resection, Stroke recurrence, Case report

Core Tip: The incidence of ischemic stroke caused by cardiac mucinous tumors has been reported both nationally and internationally. Still, it is rarely reported that intravenous thrombolytic bridging artery retrieval with same-day open thoracotomy for left atrial mucinous tumors is performed in the early stage of stroke. We treated a case with cerebral embolic stroke associated with cardiac myxoma, the embolus was successfully removed, and the cardiac tumor was extirpated surgically on the day of presentation.