Acute cerebral infarction of anterior circulation in a patient with the common trunk of the left common carotid artery and the brachiocephalic trunk:a case report

Abstract Introduction: The common trunk of the left common carotid artery and the brachiocephalic trunk (LCCA&BT) is a rare congenital vascular anomaly. Unexplained bilateral infarcts are uncommon, and their mechanisms are unknown. After searching the relevant literature, there is no report of acute anterior circulation cerebral infarction of the left common carotid artery and the brachiocephalic trunk at home and abroad. Patient concerns: A 77-year-old right-handed elderly man with good past health and no family history of stroke came to the acute stroke ward for "sudden right limb weakness for 3 days". Preexisting diabetes mellitus with normal blood sugar control and no other risk factors for cerebrovascular disease. Diagnosis: CTA of the head and neck showed that the left common carotid shared the trunk with the brachiocephalic trunk, which replaced the normal cervical vascular structures, including the brachiocephalic and common carotid arteries. Cranial magnetic resonance plain scan showed high diffusion-weighted imaging(DWI) signal in the left lateral ventricle and right frontal subcortex, and low apparent diffusion coefficient(ADC) signal in the left lateral ventricle. Cranial magnetic resonance dynamic enhancement confirmed bilateral frontal lobe acute cerebral infarction, scattered ischemic lesions and softening lesions in the brain. However, the source of thrombus in the ischemic focus of the patient could not be judged. Intervention : Considering that the patient had acute anterior circulation cerebral infarction, antiplatelet, lipid-lowering, plaque stabilization, and blood sugar control treatments were given. Outcomes: After our treatment, the patient's symptoms were relieved, and there was no dizziness, no unstable walking, no recurrence of acute cerebral infarction, and a good recovery after 3 and 6 months of follow-up. Conclusion: This case highlights the importance of the common trunk of the left common carotid artery and the brachiocephalic trunk in the occurrence of unexplained bilateral stroke. In the absence of traditional risk factors and other evidence, cerebral infarction in the blood supply area of malformed vessels should be considered vascular malformation related, but its exact pathogenesis remains unclear. Antiplatelet therapy, lipid lowering, and plaque stabilization are effective methods to prevent new infarction in such patients.