2023 Volume 45 Issue 6 Pages 505-509
A 90-year-old woman, being treated with apixaban for chronic atrial fibrillation, was transferred to our hospital with consciousness disturbance and right hemiplegia. Head MRI/A revealed acute cerebral infarction in the whole territory of the left posterior cerebral artery and occlusion at the P1 segment of the artery. Chest roentgenogram showed the right-sided aortic arch and the following contrast-enhanced CT revealed a Kommerell’s diverticulum (KD) complicated with aberrant left subclavian artery. From the filling defect in the diverticulum, we suspected that the thrombus in the KD was the cause of the embolic cerebral infarction. KD is a congenital malformation formed in the process of aortic arch formation and is often found incidentally when searching concomitant anomaly of the right-sided aortic arch. When KD causes symptoms due to its expansion and compression to adjacent organs, it eventually leads to fatal complications, rupture or dissection, and swift surgical repair is recommended. Although cerebral complications may occur secondary to rupture or dissection, ischemic stroke due to thrombus in the KD has not been reported. We present a very rare case of high-aged cerebral infarction caused by KD and treated with another direct oral anticoagulant, rivaroxaban.
