Case report: Artery of Percheron infarction as a rare complication during atrial fibrillation ablation

Abstract

The incidence of stroke or transient ischemic attacks (TIA) in atrial fibrillation (AF) catheter ablation procedures is around 1% and may be unnoted under anesthesia. The artery of Percheron (AOP) infarction is a rare kind of stroke with heterogeneity in manifestation, which further makes the perioperative early detection and diagnosis a challenge. Herein, we present one patient who underwent AF ablation and presented mental status alteration after withdrawing anesthetics. An emergency head CT was obtained, which revealed no apparent pathological changes. A late MRI test confirmed the diagnosis of AOP infarction. With oral anticoagulants and rehabilitation therapies, the patient's awareness improved and fully recovered on the sixth-month follow-up. Variability in manifestation, no positive radiological finding on initial CT, and a low incidence has made few clinicians to gain much experience with this type of infarct, which delays the diagnosis and initiation of appropriate treatment.

Keywords: artery of Percheron; atrial fibrillation; catheter ablation; complication; stroke.

FIGURE 1

(A,B) Preoperative left atrium computed tomography (CT) angiography excludes the intracardiac thrombus.

FIGURE 2

(A) Axial diffusion-weighted magnetic resonance imaging (MRI) showing bilateral paramedian thalamic hyperintense signal due to restricted diffusion and (B) no involvement on the midbrain level.

FIGURE 3

Axial magnetic resonance imaging (MRI) presenting bilateral high-signal intensity on the paramedian thalamus in (A) T2-weighted sequence, and (B) FLAIR sequence.

FIGURE 4

Variants of the vascular anatomy of the thalami and the midbrain. AOP, artery of Percheron; BA, basilar artery; M, midbrain; PCA, posterior cerebral artery; T, thalamus.