Abstract
BackgroundDiastolic retrograde flow in the descending aorta (DAo) may occur in the presence of atherosclerosis and may be overlooked as a mechanism of retrograde embolization in patients with stroke. We performed thoracic endovascular aortic repair (TEVAR) in a patient with recurrent cerebral infarctions for treatment of aortic aneurysm with atheromatic plaque, which was considered as the source of embolism.Case presentationA 56-year-old man with a history of idiopathic thrombocytopenia and hypertension was referred to our hospital with paralysis of the right upper and lower limbs. Multiple cerebral infarctions were found and treated; however, 1 month later, another cerebral infarction developed. A small saccular aortic aneurysm with plaque was found beyond the left subclavian artery, and this site was deemed as the source of embolism. We performed TEVAR to prevent further recurrence of cerebral infarctions. No cerebral infarctions were observed 6 months post-operation.ConclusionsTEVAR is a useful treatment for not only aortic aneurysm and dissection, but also cerebral infarctions caused by an embolic source proximal to the DAo due to retrograde aortic blood flow.
Highlights
Diastolic retrograde flow in the descending aorta (DAo) may occur in the presence of atherosclerosis and may be overlooked as a mechanism of retrograde embolization in patients with stroke
thoracic endovascular aortic repair (TEVAR) is a useful treatment for aortic aneurysm and dissection, and cerebral infarctions caused by an embolic source proximal to the DAo due to retrograde aortic blood flow
Evidence has indicated that arterial stiffness and wall thickness, which are associated with aging and atherosclerosis, can lead to flow reversal due to a mismatch between peripheral and central arterial stiffness [3, 4]
Summary
Flow reversal in the thoracic aorta was believed to be a sign of aortic regurgitation. Retrograde blood flow originates in the first 20–30 mm of the proximal DAo and can reach all brain-supplying arteries [2]. Atheromas at this site may cause embolic stroke in any brain territory [2]. If 4D-MRI could be performed, it would be clearer that the cause of the stroke was the atheromatic plaque, but it was not possible at our institution. TEVAR is a useful treatment for cerebral infarction caused by an embolic source proximal to the DAo due to retrograde aortic blood flow. We hope that this case report will help in the treatment of cryptogenic stroke
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