A case of left middle cerebral artery occlusion during catheter ablation for paroxysmal ventricular tachycardia

Abstract

Ischemic stroke is a severe complication of cardiac catheterization surgery, but few reports have examined the risk of perioperative stroke in left ventricular endocardial ablation. Our case is a 74-year-old man. He was referred to our cardiologist for ablation after a ventricular tachycardia attack with hypotension. The ablation was performed under local anesthesia, and the patient was referred to our department because aphasia appeared immediately after the transarterial catheter was inserted into the left ventricle. He presented with total aphasia and right upper limb paralysis; his NIHSS score was 19. After performing cerebral angiography, which showed distal occlusion of the left MCA M1 segment, we performed a mechanical thrombectomy using a combined technique. After the first pass, we obtained thrombolysis in cerebral infarction (TICI) Grade 3. Symptoms improved immediately, and the NIHSS score was 0 the next day. The pathology of the embolus was fibrin thrombus, and a subsequent transesophageal echocardiogram showed a movable plaque in the aortic arch. We considered it essential to collaborate with the cardiologist and share the stroke risk, including considering the access route when performing left ventricular endocardial ablation.