Mechanical thrombectomy for a cerebral fat embolism

Excerpt

A 56-year-old patient underwent a right knee replacement under spinal anesthesia. At the end of the procedure, he suddenly developed right hemiplegia and aphasia. Emergent brain computed tomography (CT) revealed a left middle cerebral artery occlusion by material of negative density (− 33 Hounsfield Unit), highly suggestive of fat embolus (Fig. 1a). Indeed, this image differs from the typical hyperdense artery sign, which shows thrombus. Mechanical thrombectomy was successfully achieved by thrombo-aspiration (Fig. 1b) and retrieved spumous fat fragments (Fig. 1c). In this context of acute setting during orthopedic surgery, an intra-cardiac right-left shunt was searched during diagnostic work-up. Transesophageal echocardiography revealed a patent foramen ovale with an atrial septal aneurysm, supporting a paradoxical embolism of fat material released during surgery. The patient recovered well.

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