Immediate Angioscopic Investigation After Cerebral Artery Thrombectomy Revealed Aortogenic Cerebral Infarction

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Medicine

Background:

• Aortogenic embolism is a challenging cause of embolic stroke of undetermined source.
• Diagnosis can be difficult, often requiring advanced imaging and procedural techniques.

Purpose of the Study:

• To present a case of aortogenic cerebral infarction diagnosed using angioscopy.
• To highlight the utility of angioscopy in identifying aortic thrombus as a source of embolic stroke.

Main Methods:

• A 74-year-old male with a history of Bentall surgery and thoracic endovascular aortic repair presented with acute stroke symptoms.
• Emergency mechanical thrombectomy was performed for left middle cerebral artery occlusion.
• Intraoperative aortic angioscopy was utilized to investigate the source of embolism.

Main Results:

• Angioscopy revealed a thrombus on an artificial aortic blood vessel near the left common carotid artery origin.
• Electrocardiography and ultrasound ruled out other embolic sources.
• Pathological findings of the thrombus confirmed the diagnosis of aortogenic cerebral infarction.

Conclusions:

• This is the first report detailing the use of angioscopy for immediate diagnosis of aortogenic cerebral infarction post-thrombectomy.
• Angioscopy is a valuable tool for identifying aortic pathology as a source of embolic stroke.