Immediate Angioscopic Investigation After Cerebral Artery Thrombectomy Revealed Aortogenic Cerebral Infarction

Background: Aortogenic embolism is one of the causes of embolic stroke of undetermined source, which can be difficult to diagnose. Methods: We present the case of a 74-year-old male patient with a history of Bentall surgery and thoracic endovascular aortic repair who was transported to our hospital with sudden-onset right-sided hemiplegia and total aphasia. Magnetic resonance imaging revealed an acute left middle cerebral artery occlusion. Subsequently, an emergency mechanical thrombectomy was performed, through which the left middle cerebral artery was partially reperfused. We immediately investigated the aorta using an angioscopy. Results: The angioscopy revealed a thrombus attached to an artificial blood vessel of the aorta close to the origin of the left common carotid artery. Because no other source of the embolus could be identified using electrocardiography or ultrasound, we diagnosed an aortogenic cerebral infarction by combining these findings with the pathological findings of the collected thrombus. Conclusions: This is the first report that aortogenic cerebral infarction could be diagnosed using an angioscopy immediately after a cerebral artery thrombectomy.