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.