A case of atherothrombotic brain infarction with artery-to-artery embolism and recanalization of the horizontal segment of the lefe middle cerebral artery by antithrombotic therapy

Abstract

A 69-year-old and right-handed man suddenly suffered from sensory sphasia An occlusion of the horizontal segment of the left middle cerebral artery (MCA) was revealed by intra-arterial digital subtraction angiography (IA-DSA) on day 1. This patient was diagnosed as having atherothrombotic brain infarction. After he had been administered argatroban intravenously, his sensory aphasia was converted to motor aphasia and he became clearly right hemiparetic including his face on day 2. On day 8, MR angiography demonstrated relatively good running off from his left MCA On day 21, IA-DSA was performed again and recanalization of the horizontal segment of the left MCA accompanied by 90% residual stenosis was observed. The cortical infarction in this case was estimated to be an artery-to-artery embolism due to thrombi which had formed at the stenotic MCA lesion. It is suggested that in some cases of atherothrombotic brain infarction, antithrombotic therapy can produce recanalization and artery-to-artery embolism.