1Almamoon I. Justaniah, 2Mohamed A. Omar, 2Hassan Aljaziri, 2Abdulaziz M. Tashkandi

1King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia; 2King Abdullah Medical City, Makkah, Saudi Arabia



To present a case of ischemic stroke post transarterial chemoembolization (TACE) in patient with right to left shunt due to pulmonary sequestration.

Material(s) and Method(s):

A 68-year-old male presented with a right hepatocellular carcinoma. TACE was performed via the left radial artery. A pulmonary sequestration was noted during the procedure, with arterial supply from the phrenic artery ,which was arising from the celiac axis, representing a right to left shunt.


The TACE was technically successful. No reflux was noted during the procedure. On postoperative day one, the patient developed slurred speech and changes in the level of consciousness. MRI brain revealed multifocal ischemic infarcts with an embolic pattern, likely secondary to the right to left shunt. The patient was referred to neurology for further management and rehabilitation.


Few ischemic stroke cases have been reported post TACE with different etiologies. This case is unusual due to the presence of a right to left shunt from pulmonary sequestration.