When the fat hits the brain—salvage STA–MCA bypass for an intracranial ICA occlusion due to a fat embolus

BACKGROUND: Large fat embolus is a rare but potential reversible cause of ischaemic stroke. METHODS AND RESULTS: We describe the neurosurgical management of a complete right internal carotid artery occlusion due to a large fat embolus, caused by a mitral valve replacement. CONCLUSION: Knowledge of acute cerebral ischaemia due to large fat embolism and its hallmark 'hypodense artery' is mandatory. Extracranial to intracranial bypass is a feasible rescue treatment after failure of endovascular embolectomy.