Ischemic Stroke Secondary to Arterial Tunica Media Embolism Following Percutaneous Coronary Intervention: An Uncommon Etiology

TL;DR

A rare case of ischemic stroke after a heart procedure was caused by an unusual type of embolism from the arterial wall.

Contribution

This paper reports the first documented case of stroke caused by arterial tunica media embolism following PCI.

Findings

A 57-year-old female developed stroke symptoms during PCI due to arterial tunica media embolism.

Histological analysis confirmed the emboli were fragments of the arterial wall, not typical plaque or thrombus.

The case highlights a previously unreported complication of PCI requiring increased clinical awareness.

Abstract

Ischemic stroke following percutaneous coronary intervention (PCI) is a rare complication, with an overall incidence of 0.56%. Most embolic strokes result from the dislodgement of atherosclerotic plaques, thrombi formed on catheter surfaces, procedural maneuvers, or, less commonly, air or metallic emboli originating from fractured guidewires. We present a unique case of stroke following PCI due to a previously unreported mechanism—arterial tunica media embolization associated with arterial access. A 57-year-old female presented with chest pain at rest and with exertion, accompanied by episodes of anxiety and fluctuating blood pressure, for which coronary angiography was performed, revealing 90–99% stenosis of the left anterior descending artery and necessitating PCI. During the procedure, the patient developed an eye deviation, aphasia, and left-sided hemiparesis. Cerebral angiography identified a M2 segment occlusion of the right middle cerebral artery (MCA) and a subocclusion of the right anterior cerebral artery (ACA). Thrombectomy was performed, retrieving two white, tubular emboli resembling fragments of a vessel wall, histologically confirmed to be arterial tunica media. While PCI is associated with a low complication rate, its increasing frequency necessitates awareness of emerging complications. This case underscores a previously undocumented potential embolic complication arising from the performance of PCI.

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