False patency, true occlusion: perfusion imaging and dual stent-retriever thrombectomy for a calcified carotid terminus embolus
- 1Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou, Fujian, 350001, China
- 2Corresponding author.
Abstract
Calcified cerebral emboli are an uncommon cause of acute ischemic stroke and may produce a false-patency sign on computed tomography angiography because their high attenuation can mimic intravascular contrast material. We report the case of a 77-year-old woman who presented with a wake-up stroke approximately 14 hours after she was last known well, with right hemiplegia and global aphasia. Noncontrast computed tomography showed a markedly hyperattenuating intraluminal focus at the left carotid terminus and proximal M1 segment, suggesting a calcified cerebral embolus. Computed tomography angiography appeared to show severe stenosis with residual luminal patency, whereas computed tomography perfusion demonstrated extensive hypoperfusion involving the left middle cerebral artery and bilateral anterior cerebral artery territories. Because the severe neurologic deficit and perfusion abnormality were discordant with the apparent patency on computed tomography angiography, cerebral angiography was performed. Digital subtraction angiography demonstrated complete occlusion of the left M1 origin and near-complete occlusion of the left A1 segment; the right A1 segment was congenitally hypoplastic. A rigid calcified embolus spanning the carotid-terminus bifurcation was retrieved using a balloon guide catheter-assisted dual-stent technique under proximal flow arrest, achieving complete reperfusion in a single pass. Histopathologic examination confirmed calcified embolic material. This case highlights the value of multimodal imaging and confirmatory angiography when clinical and imaging findings are discordant. In this patient, balloon guide catheter-assisted dual-stent retrieval was a tailored and feasible strategy; however, a single case cannot establish its superiority over other thrombectomy approaches.
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BibTeX
@article{mingzhuhuang2026false,
title = {{False patency, true occlusion: perfusion imaging and dual stent-retriever thrombectomy for a calcified carotid terminus embolus}},
author = {Mingzhu Huang, MD and Shujuan Gan, MMed and Jinfeng Miao, MD and Ruihan Zhu, MMed and Jintao Chen, MMed and Wenhuo Chen, MMed},
journal = {Radiology Case Reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.09.076},
url = {https://doi.org/10.1016/j.radcr.2026.09.076},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - False patency, true occlusion: perfusion imaging and dual stent-retriever thrombectomy for a calcified carotid terminus embolus
AU - Mingzhu Huang, MD
AU - Shujuan Gan, MMed
AU - Jinfeng Miao, MD
AU - Ruihan Zhu, MMed
AU - Jintao Chen, MMed
AU - Wenhuo Chen, MMed
PY - 2026
DA - 2026/10/24
JO - Radiology Case Reports
DO - 10.1016/j.radcr.2026.09.076
UR - https://doi.org/10.1016/j.radcr.2026.09.076
AB - Calcified cerebral emboli are an uncommon cause of acute ischemic stroke and may produce a false-patency sign on computed tomography angiography because their high attenuation can mimic intravascular contrast material. We report the case of a 77-year-old woman who presented with a wake-up stroke approximately 14 hours after she was last known well, with right hemiplegia and global aphasia. Noncontrast computed tomography showed a markedly hyperattenuating intraluminal focus at the left carotid terminus and proximal M1 segment, suggesting a calcified cerebral embolus. Computed tomography angiography appeared to show severe stenosis with residual luminal patency, whereas computed tomography perfusion demonstrated extensive hypoperfusion involving the left middle cerebral artery and bilateral anterior cerebral artery territories. Because the severe neurologic deficit and perfusion abnormality were discordant with the apparent patency on computed tomography angiography, cerebral angiography was performed. Digital subtraction angiography demonstrated complete occlusion of the left M1 origin and near-complete occlusion of the left A1 segment; the right A1 segment was congenitally hypoplastic. A rigid calcified embolus spanning the carotid-terminus bifurcation was retrieved using a balloon guide catheter-assisted dual-stent technique under proximal flow arrest, achieving complete reperfusion in a single pass. Histopathologic examination confirmed calcified embolic material. This case highlights the value of multimodal imaging and confirmatory angiography when clinical and imaging findings are discordant. In this patient, balloon guide catheter-assisted dual-stent retrieval was a tailored and feasible strategy; however, a single case cannot establish its superiority over other thrombectomy approaches.
SN - 1930-0433
ER -