Abstract
A 59-year-old man, who has cutaneous polyarteritis nodosa, presented with sudden onset of excruciating neck pain and syncope. Chest CT disclosed a Stanford type a acute aortic dissection. He rapidly lost consciousness and cardiac tamponade caused a drop in blood pressure. Emergency ascending aortic replacement proceeded under deep hypothermic circulatory arrest with antegrade selective cerebral perfusion and the cerebral blood supply was monitored throughout the procedure. However, post-operative brain CT imaging revealed extensive right hemispheric brain infarction. A large thrombus was identified in the right internal carotid artery. Whether the mechanism of brain ischemia associated with the aortic dissection was hemodynamic ischemia or thromboembolism remained unclear. We considered that thrombectomy might be needed before selective cerebral perfusion.
Highlights
Free-floating thrombus in the internal carotid artery is rare, its incidence is unknown and its management remains controversial
We describe ischemic stroke caused by thromboembolism with free-floating thrombus in the internal carotid artery due to type A aortic dissection
Cerebral infarction could be due to common carotid occlusion or artery-to-artery embolism from a thrombus on the intimal surface of the dissected artery
Summary
Free-floating thrombus in the internal carotid artery is rare, its incidence is unknown and its management remains controversial. Neurological disorders such as the initial manifestation of type A aortic dissection become more difficult to diagnose. We describe ischemic stroke caused by thromboembolism with free-floating thrombus in the internal carotid artery due to type A aortic dissection.
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