Successful carotid artery stenting in patients with aortic dissection
1Department of Neurology, Chosun University School of Medicine, 61453 Gwangju, South Korea
2Department of Neurosurgery, Chosun University School of Medicine, 61453 Gwangju, South Korea
3Department of Neurology, Jeonbuk National University School of Medicine, 54907 Jeonju, South Korea
DOI: 10.22514/sv.2020.16.0089 Vol.17,Issue 2,March 2021 pp.223-227
Published: 08 March 2021
† These authors contributed equally.
Background: There are no guidelines for the optimal timing of surgery (emergency vs. delayed) for ascending aortic dissection with acute ischemic stroke. We retrospectively compared the prognoses and radiological and clinical findings for concomitant aortic dissection and ischemic stroke in a series of case reports.
Case presentation: Three patients presented with left hemiparesis. Patient 1 underwent surgery for acute aortic dissection without treatment for acute ischemic stroke. In Patient 2, emergency stenting could not be performed due to cardiac tamponade and hypotension. Therefore, emergency acute aortic dissection surgery was performed. Patient 3 underwent emergency right common carotid artery stenting followed by surgery for acute aortic dissection. Brain perfusion computed tomography angiography (CTA) was performed to diagnose severe stenosis of the right common carotid artery or occlusion concomitant with acute aortic dissection involving the aortic arch with a cerebral perfusion mismatch in all the patients. Patient 3 had postoperative local cerebral infarction, whereas patients 1 and 2 (without stent insertion) had extensive postoperative cerebral infarction.
Conclusion: Patient 3 showed a better prognosis than patients without stent treatment. We suggest that perfusion CTA of the aortic arch in suspected acute ischemic stroke can facilitate early diagnosis and prompt treatment in similar patients.
Acute stroke; Aortic arch; Aortic dissection; Common carotid artery; Stent
Pahn-Kyu Choi,Sang-Woo Ha,Byoung-Soo Shin,Hyun-Goo Kang. Successful carotid artery stenting in patients with aortic dissection. Signa Vitae. 2021. 17(2);223-227.
 Pacini D, Di Marco L, Fortuna D, Belotti LM, Gabbieri D, Zussa C, et al. Acute aortic dissection: epidemiology and outcomes. International Journal of Cardiology. 2013; 167: 2806-2812.
 Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013; 128: S175-S179.
 Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. Journal of the American Medical Association. 2000; 283: 897-903.
 Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002; 122: 311-328.
 Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological symptoms in type A aortic dissections. Stroke. 2007; 38: 292-297.
 Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous Alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47: 581-641.
 Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection. American Journal of Cardiology. 2007; 99: 852-856.
 Chua CH, Lien LM, Lin CH, Hung CR. Emergency surgical intervention in a patient with delayed diagnosis of aortic dissection presenting with acute ischemic stroke and undergoing thrombolytic therapy. Journal of Thoracic and Cardiovascular Surgery. 2005; 130: 1222-1224.
 Noel M, Short J, Farooq MU. Thrombolytic therapy in a patient with acute ischemic stroke caused by aortic dissection. Clinical Neurology and Neurosurgery. 2010; 112: 695-696.
 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010; 121: e266-e369.
 Matsubara S, Koga M, Ohara T, Iguchi Y, Minatoya K, Tahara Y, et al. Cerebrovascular imaging of cerebral ischemia in acute type A aortic dissection. Journal of the Neurological Sciences. 2018; 388: 23-27.
 Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. American Journal of Cardiolog. 1984; 53: 849-855.
 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. European Heart Journal. 2014; 35: 2873−2926.
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