Misplaced Arterial Pacemaker Lead.

A 90 year old man presented with an ischaemic stroke and haemorrhagic transformation in the left posterior cerebral artery territory. Chest Xray (A) and a computed tomography angiogram (CTA; B) showed a misplaced pacemaker lead entering the left subclavian artery (LSA, a), anchored in the left ventricular apex through the ascending aorta (b). Lead extraction with covered stent placement in the LSA was proposed, but the patient refused. Bridging therapy with acetylsalicylic acid 100 mg daily was administered for two weeks. With no new cerebral CTA changes, 110 mg of dabigatran twice daily was prescribed. The patient remained well after six months follow up. [...