Cerebral Infarction Caused by a Tortuous Subclavian Artery: a Case Report
A 35-year-old male patient was admitted with headache, visual disturbance and left hemiparesis. He had no history of hypertension, diabetes mellitus or other cardiac disease, and he was currently a 10-pack-per-year smoker. The headache was described as feeling like a tight band around his head. He denied any nausea or vomiting. The neurological examination results were normal, although he complained of numbness in his left side. Upon admission, his vital signs were stable. A chest X-ray and laboratory findings were normal. Brain magnetic resonance image (MRI) revealed an acute infarction in the right lateral thalamus (). Brain CT angiography indicated a severe tortuosity with elongation at the right subclavian artery and stenosis at the right posterior cerebral artery. Negative transthoracic and transesophageal echocardiogram and Holter monitoring ruled out a cardiac source of the embolus. Hypercoagulation tests for antinuclear antibody, anticardiolipin, antithrombin III, protein C, protein S and lupus anticoagulant were all negative.\nDigital subtraction angiography demonstrated a severe tortuosity with elongation of the right subclavian artery (). The carotid vessels on both sides were normal. On hospital day 4, he underwent a right subclavian exposure through a supraclavicular approach. The wall of the proximal right subclavian artery was tortuous and enlarged. The abnormal right subclavian artery was resected after clamping the diseased portion at both ends. The proximal right subclavian artery was then anastomosed directly at the right common carotid artery directly. After an end to end anastomosis, magnetic resonance angiography (MRA) revealed recanalization of the subclavian artery (). The histopathological findings revealed tortuous lumen and myxoid degeneration of the wall without evidence of vasculitis ().