Aortogenic embolic stroke (AES) is an important stroke mechanism. However, as many stroke patients have aortic atheromatous lesions, it is unclear whether these lesions are the cause of these strokes. Cholesterol crystals are the solid, crystalline form of cholesterol that is found in atherosclerosis, but not in cardiac diseases such as atrial fibrillation, valvular diseases, and cardiomyopathy. Therefore, if a cholesterol crystal is found in a thrombus removed by mechanical thrombectomy (MT), this makes it possible to diagnose a patient as having an atheromatous lesion. Here, we report an AES case with a cholesterol crystal found in a thrombus removed by MT. A 67-year-old man was admitted due to consciousness disturbance, aphasia, and right hemiplegia. Diffusion-weighted imaging (DWI) showed a hyperintense area in the left frontal lobe, and magnetic resonance angiography demonstrated a branch occlusion of the left middle cerebral artery (MCA). MT was performed 1.5 h after stroke onset, with the thrombus removed and a left occluded MCA completely recanalized. Carotid duplex ultrasonography did not reveal any plaque in the carotid artery. Echocardiography did not show any abnormal function or findings, including thrombus. Transesophageal echocardiography showed a 4.9 mm atheromatous lesion at the aortic arch. Therefore, we suspected this patient as having an AES due to the embolic source of atheromatous lesion at the aortic arch. Pathological examination of the embolus revealed a cholesterol crystal cleft in the thrombus. Therefore, we diagnosed this patient as having AES caused by an atheromatous lesion at the aortic arch.

主动脉栓塞性中风（AES）是重要的中风机制。然而，由于许多中风患者具有主动脉动脉粥样硬化病变，因此尚不清楚这些病变是否是这些中风的原因。胆固醇晶体是胆固醇的固体结晶形式，存在于动脉粥样硬化中，但在心脏疾病（例如心房纤颤，瓣膜疾病和心肌病）中却没有。因此，如果在通过机械血栓切除术（MT）去除的血栓中发现胆固醇晶体，则可以诊断出患者患有动脉粥样硬化病变。在这里，我们报告了AES病例，该病例在MT清除的血栓中发现了胆固醇晶体。一名67岁的男子因意识障碍，失语症和右半身不遂而入院。弥散加权成像（DWI）显示左额叶有高强度区域，磁共振血管造影显示左大脑中动脉（MCA）分支阻塞。中风发作后1.5 h进行MT，去除血栓，完全闭塞左侧闭塞的MCA。颈动脉双工超声检查未发现颈动脉斑块。超声心动图未显示任何异常功能或发现，包括血栓。经食道超声心动图检查发现主动脉弓处有4.9 mm的动脉粥样硬化病变。因此，由于主动脉弓的动脉粥样硬化病变的栓塞源，我们怀疑该患者患有AES。栓子的病理检查发现血栓中有胆固醇晶体裂口。因此，我们诊断出该患者患有由主动脉弓上的动脉粥样硬化病变引起的AES。