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

Figures

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  Fig. 1. Relevant information for patient 1. Craniocerebral CTA indicating basilar artery occlusion (A). Cerebral perfusion imaging suggesting the presence of an ischemic penumbra (B). Preoperative Digital Subtraction Angiography (DSA) showing basilar artery occlusion (C), postoperative imaging confirming recanalization with an mTICI grade 3 (D). Cranial Diffusion-Weighted Imaging (DWI) on postoperative day 1 showing acute cerebral infarction in the brainstem and cerebellum (E). Histopathology of the retrieved embolus shows coagulated blood and fibrinous material without atypical cells, confirming thrombotic origin(200×) (F). Cardiac CT enhancement suggesting an atrial myxoma (G), pathological examination of the resected cardiac tumor confirming atrial myxoma(200×) (H)

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  Fig. 2. Partial information for patient 2. Intraoperative DSA confirming a left internal carotid artery occlusion and right middle cerebral artery stenosis (A, C). Lower-limb DSA indicating an embolism in the left femoral artery (E). Postoperative DSA showing restored patency of the left internal carotid and right middle cerebral arteries with an mTICI grade 3 (B, D). Partial removal of the emboli in the lower limb arteries (F)

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  Fig. 3. Additional details for patient 2. Echocardiography suggesting a possible atrial myxoma (A). Postoperative cardiac ultrasound confirming the absence of tumors (B). Specimens harvested from the middle cerebral artery (C) and lower limb arteries (D) show myxoid stroma and scattered stellate tumour cells with CR immunoreactivity(200×), consistent with atrial myxoma emboli, and atrial myxoma in the resected cardiac tumor (200×) (E). Cranial CT demonstrating low-density lesions in both anterior and posterior circulation territories (F)