Azygous anterior cerebral artery occlusion managed with Thrombectomy: a case report and literature review

Azygous anterior cerebral artery (ACA) occlusion is a rare vascular anomaly that results in bilateral frontal infarction and carries a high morbidity rate. We present a 48-year-old male with no prior significant medical history who presented eight hours after sudden onset of right leg weakness. Initially, the National Institutes of Health Stroke Scale (NIHSS) score was four. Computed tomography angiography revealed a solitary azygous ACA with distal A2 occlusion. Mechanical thrombectomy was initially postponed due to mild deficits, but it was performed after clinical deterioration to a NIHSS score of eight. The procedure successfully recanalized the artery. Post-procedure magnetic resonance imaging confirmed bilateral ACA infarcts. The patient received medical therapy and rehabilitation, resulting in complete neurological recovery within three months. This case underscores the diagnostic difficulties associated with azygous ACA occlusion in patients presenting with fluctuating symptoms. Timely observation and intervention were pivotal in preventing severe disability.