Safe and Effective Intravenous Thrombolysis for Acute Ischemic Stroke Caused by Left Atrial Myxoma

• Published in: Journal of stroke and cerebrovascular diseases Vol. 18; no. 5; pp. 398 - 402
• Main Authors: Nagy, Christian D., MD, Levy, Michael, MD, PhD, Mulhearn, Thomas J., MD, Shapland, Maryam, MD, Sun, Henry, MD, Yuh, David D., MD, Cheung, Dickson, MD, Chandra-Strobos, Nisha, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2009
• Subjects: Acute Disease - therapy; Adult; atrial myxoma; Brain - blood supply; Brain - pathology; Brain - physiopathology; Brain Ischemia - drug therapy; Brain Ischemia - etiology; Brain Ischemia - pathology; Cardiac Surgical Procedures; Cardiovascular; Cerebral Arteries - drug effects; Cerebral Arteries - pathology; Cerebral Arteries - physiopathology; Echocardiography, Transesophageal; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Atria - surgery; Heart Neoplasms - complications; Heart Neoplasms - pathology; Heart Neoplasms - surgery; Humans; Injections, Intravenous; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Myxoma - complications; Myxoma - pathology; Myxoma - surgery; Neurology; recombinant tissue plasminogen activator; Stroke; Stroke - drug therapy; Stroke - etiology; Stroke - pathology; thrombolysis; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Treatment Outcome; recombinant tissue plasminogen activator; thrombolysis; Stroke; atrial myxoma
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2008.11.012

Atrial myxoma may be associated with syncope or sudden death attributed to left-sided cardiac outflow obstruction or embolization caused by tumor dislodgement or thrombus formation. Definitive treatment for primary and secondary stroke prevention is surgical resection. The role of thrombolysis in acute brain ischemia in patients with atrial myxoma is not defined. There are few data available regarding safety and efficacy of thrombolytic therapy in acute ischemic strokes caused by atrial myxoma. Prior case reports described partial success using intra-arterial local thrombolysis; however, this is invasive and can be associated with significant complications. A previously reported case of systemic thrombolysis resulted in development of cerebral hemorrhage. We describe a young man who presented with syncope and a dense stroke developing as a complication of atrial myxoma, followed by a remarkable recovery after treatment with intravenous recombinant tissue plasminogen activator and urgent cardiac surgery. Contrary to some expert opinion, systemic thrombolytic therapy may be safely and effectively used to treat acute ischemic strokes from atrial myxoma.