Abstract
Objective: We report a rare case of left middle cerebral artery embolism due to fibromuscular dysplasia (FMD) in the cervical internal carotid artery.
Case presentation: A 47-year-old female presented with motor aphasia and right hemiparesis. MRI showed early ischemic changes in the left frontal lobe and insular cortex. Cervical MRA showed irregularity of the vessel wall in the left cervical internal carotid artery and occlusion of the left middle cerebral artery (MCA). Because the patient was ineligible for intravenous recombinant tissue plasminogen activator, we chose endovascular therapy for recanalization. A left common carotid angiogram demonstrated typical findings of FMD and occlusion extending from the distal M1 to M2 segment of the MCA. Therefore, we performed balloon catheter disruption of the thrombus without thrombectomy using a Merci retriever. The occluded MCA was successfully recanalized and good clinical outcome was obtained.
Conclusion: We considered that the left MCA occlusion was caused by artery-to-artery embolism derived from FMD. This is the first report of balloon catheter disruption of the thrombus due to FMD.
