A Stranger in the Middle Cerebral Artery

Excerpt

A 78-year-old man presented at our department 7 days after successful percutaneous transluminal bare metal stent-assisted dilatation of a 95 % stenosis of an aortocoronary venous bypass graft to the left anterior descendent coronary artery with three transient episodes of Broca’s aphasia. The patient did not adhere to the recommended dual antiplatelet therapy with aspirin and clopidogrel. Cerebral computed tomography revealed that a high-grade stenosis of the distal M1 segment of the middle cerebral artery (MCA) caused by a stranger within the arterial lumen (Fig. 1), which to our surprise resembled a coronary stent in shape and size. The interventional cardiologist who had performed the coronary stent placement reported the loss of one bare metal stent during the procedure (Fig. 2) and—because the patient was asymptomatic—had discharged the patient 2 days later. Recovery of the stent from the MCA was discussed but considered a high-risk intervention. Dual antiplatelet therapy was restarted instead, and no further transient ischemic attacks occurred. The patient was last seen well 3 years after initial presentation.

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