Recanalization using a balloon-mounted stent in calcified cerebral emboli

Calcified cerebral emboli (CCE) are a rare cause of acute ischaemic stroke, typically arising from calcified cardiac valves or atherosclerotic plaques. Although often visible on non-contrast CT, they are frequently mistaken for haemorrhage or vascular calcification and respond poorly to thrombolysis or thrombectomy. We present a man in his early 80s with atrial fibrillation, chronic obstructive pulmonary disease (COPD) and extensive aortic calcification who developed recurrent right arm weakness after withholding anticoagulation for an angiographic procedure. Imaging revealed a calcified embolus causing left middle cerebral artery (MCA) stenosis. Multiple thrombectomy attempts failed, and his neurological status declined until rescue balloon-mounted intracranial stenting restored flow, improving motor function, though expressive aphasia persisted. His course was later complicated by COPD exacerbation, leading to comfort care. This case underscores the diagnostic and therapeutic challenges of CCE and highlights balloon-mounted stenting as a potential rescue option when thrombectomy fails, while emphasising the importance of treating embolic sources to prevent recurrence.