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• Vol.47 No.10
• CLINICA NEUROL, 47: 644−649, 2007
• Vol.47 No.10 contents

Case Report

A patient with innominate artery steal accompanied with cerebral infarction

Takashi Yasuda, M.D.¹⁾, Kenji Kobayashi, M.D.²⁾, Wakoh Takahashi, M.D.¹⁾, Shunya Takizawa, M.D.¹⁾, Kazuo Kanabuchi, M.D.³⁾ and Shigeharu Takagi, M.D.¹⁾

¹⁾Department of Neurology, Tokai University School of Medicine
²⁾Department of General Internal Medicine, Tokai University School of Medicine
³⁾Department of Cardiovascular Surgery, Tokai University School of Medicine

A 49-year-old man suddenly suffered left hemiplegia, and was brought to our hospital by ambulance at the beginning of August, 2006. He had a history of hypertension, and had received replacement of a synthetic graft in the ascending aorta and aortic arch with innominate artery for dissecting aneurysm in the aorta 2 years before. On diffusion-weighted magnetic resonance images obtained after admission, cerebral infarction was detected at the right corona radiata, and MR angiography (MRA) showed obstruction of the right middle cerebral artery. He was given intravenous tissue-plasminogen activator (t-PA) a few hours after arrival, and his hemiplegia was improved on the following day. At 11 days after onset, recanalization of the right middle cerebral artery was seen by MRA. On Doppler ultrasonographic examination, obstruction and thrombus in the innominate artery were observed. Retrograde flow of the right vertebral artery was demonstrated by both pulse-Doppler ultrasonography and velocity-coded color MRA.
This patient is a rare example of innominate artery steal and ischemic cerebrovascular disease with obstruction of the innominate artery. Cerebral infarction in this patient might have developed via artery-to-artery embolism, with the thrombus in the innominate artery, rather than through a hemodynamic mechanism with innominate artery steal.

(CLINICA NEUROL, 47: 644−649, 2007)
key words: innominate artery steal, cerebral infarction, synthetic graft, magnetic resonance angiography, Doppler ultrasonography

(Received: 12-Jan-07)