Chuan-Min Lin1, Chien-Hung Chang1, Shao-Wei Chen2, Yu-Hsuan Huang3, Alvin Yi-Chou Wang4, Ching-Chang Chen4. 1. Department of Neurology, Stroke Center, Linkou Chang Gung Memorial Hospital & Chang Gung University, Taoyuan City, Taiwan. 2. Division of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. 3. Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan. 4. Department of Neurosurgery, Linkou Chang Gung Memorial Hospital & Chang Gung University, Taoyuan City, Taiwan.
Abstract
BACKGROUND: Mechanical thrombectomy is an effective management for acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be less than optimal. Herein, we presented a patient with right common carotid artery and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed. CASE DESCRIPTION: A 45-year-old male had a type A aortic dissection that presented with sudden onset neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of the ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After the aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right common carotid artery (CCA) occlusion up to the internal carotid artery (ICA). The right CCA was exposed and directly punctured. A thrombus was successfully removed, and a total of 5 stents were deployed to treat the ICA and CCA dissection. Angiography showed a final TICI 3 result, and the patient had excellent clinically recovery. CONCLUSIONS: Acute mechanical thrombectomy through open direct neck puncture due to an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.
BACKGROUND: Mechanical thrombectomy is an effective management for acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be less than optimal. Herein, we presented a patient with right common carotid artery and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed. CASE DESCRIPTION: A 45-year-old male had a type A aortic dissection that presented with sudden onset neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of the ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After the aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right common carotid artery (CCA) occlusion up to the internal carotid artery (ICA). The right CCA was exposed and directly punctured. A thrombus was successfully removed, and a total of 5 stents were deployed to treat the ICA and CCA dissection. Angiography showed a final TICI 3 result, and the patient had excellent clinically recovery. CONCLUSIONS: Acute mechanical thrombectomy through open direct neck puncture due to an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.