# 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.

## Key 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.