Introduction – Cardiac myxomas are the most common cardiac tumors that can present with a spectrum of clinical manifestations. They are an uncommon cause of cerebral stroke, and simultaneous involvement of the aorto-iliac vessels is extremely rare with 8 cases reported in the literature over the past 10 years. We provide a pictorial illustration of the radiological, surgical, and histopathological findings, which differentiates our case from others in the literature. Case presentation – A 41-year-old female was admitted with right side weakness and aphasia (NIHSS score of 15). CT and CT-angiography revealed hyperacute brain ischemia with occlusion of left M1-segment of MiddleCerebral-Artery. The patient was shifted to a thrombectomy-capable center, where the left femoral pulse was found to be absence and the right femoral artery had weak pulsations. Mechanical thrombectomy of left MCA was done. Angiography showed occlusions of the distal abdominal aorta, the bilateral common iliac arteries, the left external iliac artery and the left common femoral artery. Surgical embolectomy of peripheral vessels was done. Pathohistology of clots taken out from the cerebral as well as peripheral vessels revealed cardiac myxoma. Patient had complete recovery of the stroke as well as the lower limb ischemia. Conclusion – Atrial myxoma is a rare cause of cerebral stroke requiring a thorough investigation to reach a diagnosis. Mechanical thrombectomy is a safe and effective method for treatment of such strokes. Important to emphasize the need for a multi-disciplinary team in the management of distal embolization in these cases. Data in the literature with regards to its treatment is limited.

Background: Failure to prevent rebleeding after cerebral subarachnoid hemorrhage (SAH) is the most frequent reason for high morbidity and mortality of aneurysmal SAH. Our study aims to identify the outcome after surgical clipping of aneurysmal SAH before and after the establishment of the neurovascular unit. The clarifications of the positive turnover in the outcome will be discussed. Methods: A retrospective cohort analysis was carried out on our experience with a controlled group of patients who underwent clipping for ruptured cerebral aneurysms (n = 61) from January 2015 to December 2019. A modified Rankin scale (mRS) was used to determine the outcome after 6 months of follow-up. Results: The median mRS score (i.e., outcome) on admission was 4, whereas it was with a median score of 2 six months after clipping (P ≤ 0.001). Overall, the cases with a good outcome were 63.9% of the sample, while the poor outcome conditions were 36.1%. The most cases with an improved outcome were after introducing the neurovascular unit, representing a transition of aneurysmal clipping practice in our center. The good outcome was changed from 42% to 76.7%, and the poor outcome was changed from 58% to 23.3% (P = 0.019). The crude mortality rate was similar to the rate worldwide (18%), with a noticeable decrease after organizing a neurovascular subspecialty. Conclusion: The outcome after clipping of ruptured SAH can be largely affected by the surgeon’s experience and postoperative intensive care. Organizing a neurovascular team is one of the major factors to achieve good outcomes.