1993 Volume 15 Issue 5 Pages 392-398
We report a 46-year-old male with cerebral infarction caused by artery-to-artery embolism from right internal carotid artery stenosis. He was admitted because of progressive left hemiparesis. At admission, CT demonstrated a watershed infarction between the middle cerebral artery and posterior cerebral artery. The mechanism underlying this infarction appears to have been hemodynamic insufficiency. At the 3rd hospital day, the patient's hemiparesis suddenly worsened. CT revealed new right striatocapsular infarction. At the 7th hospital day, cerebral angiograms demonstrated 90% stenosis of the right internal carotid artery at the origin, and occlusion of the right middle cerebral artery at the trifurcation. One month later, repeated angiograms showed recanalization of the middle cerebral artery. Artery-to-artery embolism from the right internal carotid stenosis was diagnosed. Three months later, carotid endarterectomy was performed without any complications. This case suggests that artery-to-artery embolism is one of the important preventable mechanisms of cerebral infarction in patients with internal carotid artery stenosis.
