Peri-procedural recognition of a calcified cerebral embolus following mechanical thrombectomy: A case report

Calcified cerebral embolism (CCE), an uncommon but increasingly recognized cause of ischemic stroke, is often associated with technical challenges during mechanical thrombectomy (MT). The case reported here is of an octogenarian woman who presented with acute aphasia and scattered bilateral microinfarcts without large vessel occlusion, followed by recurrent aphasia 1 week later due to acute left internal carotid artery occlusion requiring MT. Despite multiple device passes, only partial reperfusion (modified Thrombolysis in Cerebral Infarction 2a) was achieved, and post-procedural computed tomography revealed a newly appeared, well-circumscribed, hyperdense lesion consistent with a calcified cerebral embolus that had not been detected on prior imaging. This case highlights the importance of recognizing CCE as a potential cause of incomplete reperfusion and procedural difficulty during MT, as well as the diagnostic value of thin-section computed tomography for detecting calcified emboli. Increased awareness of CCE may facilitate a more accurate diagnosis, guide procedural strategies, and improve etiological evaluation in embolic stroke.