We report a rare case of de novo arteriovenous malformation (AVM) after cerebral infarction (CI) that ruptured after mechanical thrombectomy (MT) at the time of recurrence of CI. A 64-year-old male had a history of left temporal CI 4 years ago. At that time, no shunt disease was demonstrated on magnetic resonance imaging (MRI). Four years later, he was admitted to our hospital with impaired consciousness and right hemiplegia. MRI showed cerebral infarction in the left middle cerebral artery area due to middle cerebral artery first portion occlusion. MT was successfully performed using combined technique. In addition, left temporal AVM was found on angiography but it was not treated at the same time. Sudden headache and nausea appeared 12 hours after MT. Head CT findings showed left temporal subcortical hemorrhage, and emergency operation was performed. Spetzler-Martin Grade II AVM was demonstrated on postoperative angiogram. Surgical resection of AVM was successfully performed 21 days after MT. It has been reported that de novo AVM is caused by various angiogenic factors. This case suggested that de novo AVM developed due to angiogenic changes caused by first CI, leading to rupture due to hemodynamic changes by another CI.
