Direct Neck Exposure for Rescue Endovascular Mechanical Thrombectomy in a Patient with Acute Common Carotid Occlusion Concurrent with Type A Aortic Dissection

Abstract

Mechanical thrombectomy is an effective treatment of acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be suboptimal. We present a patient with right common carotid artery (CCA) 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. A 45-year-old man with a type A aortic dissection presented with sudden onset of neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right CCA occlusion up to the internal carotid artery. The right CCA was exposed and directly punctured. A thrombus was successfully removed, and 5 stents were deployed to treat the internal carotid artery and CCA dissection. Angiography showed a final Thrombolysis In Cerebral Infarction 3 result, and the patient had an excellent clinical recovery. Acute mechanical thrombectomy through open direct neck puncture to treat an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.