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Recanalization using a balloon-mounted stent in calcified cerebral emboli
Pichatorn Suppakitjanusant1,2, Damla Yagmur3,2, Adam Bel Hadj Kacem4
1Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA pichatorn.suppakitjanusant@ttuhsc.edu.
BMJ Case Reports
|April 2, 2026
Summary
Calcified cerebral emboli (CCE) are a rare cause of ischemic stroke, often missed on imaging. Rescue stenting may restore flow when thrombectomy fails, but preventing emboli is key.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Calcified cerebral emboli (CCE) are an uncommon cause of acute ischemic stroke.
- CCE often originate from cardiac valves or atherosclerotic plaques.
- Diagnosis can be challenging as CCE may be mistaken for hemorrhage or vascular calcification on CT scans.
Purpose of the Study:
- To present a case of recurrent ischemic stroke caused by a calcified embolus in the middle cerebral artery.
- To highlight the diagnostic and therapeutic difficulties associated with CCE.
- To evaluate the efficacy of balloon-mounted intracranial stenting as a rescue therapy.
Main Methods:
- Case report of an elderly male with atrial fibrillation, COPD, and aortic calcification.
- Initial presentation of recurrent right arm weakness.
- Diagnostic imaging including CT, followed by endovascular treatment attempts.
Main Results:
- A calcified embolus was identified causing left middle cerebral artery stenosis.
- Multiple thrombectomy attempts were unsuccessful.
- Rescue balloon-mounted intracranial stenting successfully restored cerebral blood flow.
- Neurological function improved, but expressive aphasia persisted.
Conclusions:
- CCE pose significant diagnostic and treatment challenges in acute ischemic stroke.
- Balloon-mounted stenting can be a viable rescue option for refractory CCE cases.
- Management of embolic sources is crucial for preventing recurrent events.
