Common Carotid Artery Dissection Research Articles

Superb microvascular imaging is useful for diagnosis and follow‐up of common carotid artery dissection

Superb microvascular imaging is useful for diagnosis and follow‐up of common carotid artery dissection

Spontaneous asymptomatic common carotid artery dissection resembling a carotid web: illustrative case.

Carotid artery dissection is a common cause of ischemic stroke, predominantly affecting the internal carotid artery, with rare involvement of the common carotid artery (CCA). The limited literature makes diagnosis and management challenging, particularly in asymptomatic patients. In this report, the authors present a unique case of spontaneous, asymptomatic CCA dissection that resembled a carotid web, shedding light on its clinical spectrum and management. A 70-year-old man was diagnosed with an intimal flap in the left CCA. Although the findings resembled those of a carotid web, cerebral angiography confirmed the presence of an intimal flap and arterial wall irregularities indicative of vascular dissection. Endarterectomy successfully prevented the stroke, and the postoperative recovery was uneventful. Pathological examination confirmed the diagnosis of CCA dissection. Spontaneous CCA dissection, though rare, presents significant diagnostic and therapeutic challenges. Because of morphological similarities, differentiating the diagnosis from a carotid web can be difficult. Available treatment strategies include antiplatelet therapy and surgical intervention. In this case, endarterectomy was chosen to avoid antithrombic treatment in anticipation of further invasive treatments for other conditions. The successful outcome highlights the potential as a treatment option, emphasizing the need for an individualized approach to each patient. https://thejns.org/doi/10.3171/CASE24344.

Investigation of the Association between Bilateral Selective Anterograde Cerebral Perfusion and Postoperative Ischemic Stroke in Obese Patients with Emergency Surgery for Acute Type A Aortic Dissection.

Background and objectives: The relationship between cerebral perfusion and new postoperative ischemic stroke in obese patients is not well defined. The aim of this study was to investigate the association between selective bilateral anterograde cerebral perfusion and new postoperative ischemic stroke in obese patients with emergency surgery for acute type A aortic dissection. Materials and methods: A total of 292 patients with emergency surgery for acute type A aortic dissection were included in this study. Patients with hemorrhagic stroke or ischemic stroke with severe neurological dysfunction at admission that were not candidates for surgery; patients who died in the first 48 h after intensive care admission and patients with incomplete medical records were excluded. Results: The mean age was 59.42 ± 10.68 years and the mean Euroscore was 9.12 ± 1.63. Obesity was present in 76.4%, the incidence of new postoperative ischemic stroke was 27.5%, and the postoperative mortality rate was 26.7%. The mean cardiopulmonary bypass time was 206.81 ± 75.48 min, the aortic cross-clamp time was 118.2 ± 46.42 min, and 90% of cases required cerebral perfusion. The mean cerebral perfusion time was 30.8 ± 24.41 min. Obese patients had a higher frequency of in-hospital death (p = 0.009), smoking (p = 0.036), hypertension (p = 0.023), left common carotid artery dissection (p < 0.001), right common carotid artery dissection (p = 0.029), femoral artery cannulation (p = 0.026), aortic root replacement (p = 0.009), aortic valve replacement (p = 0.005) and early reintervention for bleeding (p = 0.004). Using logistic regression, selective bilateral anterograde cerebral perfusion over 40 min in obese patients was independently associated with new postoperative ischemic stroke (OR = 2.35; 95%CI = 1.36-4.86; p = 0.021). Conclusions: A patient-tailored strategy for cerebral perfusion should be considered in obese patients, considering the high atheromatous burden of the supra-aortic vessels in these patients and the potential risk of atheromatous embolization associated with this technique.

Successfully Procedure Endovascular Carotid Angioplasty Stent in a Case of Neck Stab Wound with Pseudoaneurysm, Recurrent Transient Ischemic Attack, and Horner Syndrome: A Case Report

Highlight: Uncommon Presentation and Diagnosis: The case report presents a unique and rare clinical scenario involving a 14-year-old boy who sustained a neck stab wound, leading to the development of a pseudoaneurysm within the common carotid artery. Multidisciplinary Approach to Treatment: The case highlights the complexity of managing such casesm where a multidisciplinary approach is paramount. The manuscript underscores the significance of involving neurology, interventional neurology, and vascular surgery teams to provide comprehensive and tailored patient care Efficacy of Endovascular Intervention: The successful outcome of the endovascular carotid angioplasty stent procedure highlights its effectiveness as a treatment option for addresing complex vascular conditions like pseudoaneurysm or dissection of the carotid artery. ABSTRACT Introduction: Neck stab wounds can lead to various vascular complications, including pseudoaneurysm or carotid artery dissection. Proper diagnosis and management can prevent recurrent strokes. Case: We reported a case of a 14-year-old boy with a previous left neck stab wound who developed recurrent transient ischemic attacks (TIAs) accompanied by Horner's syndrome and headache following a traumatic common carotid artery dissection. An angiographic examination revealed a pseudoaneurysm or dissection of the left common carotid artery. The patient was initially treated with oral anticoagulant therapy, but he continued to experience recurrent TIA. The patient was then treated endovascularly with a carotid angioplasty stent to restore the compromised carotid artery. Following the endovascular procedure, the patient experienced no complications, showed improvement in Horner syndrome, and had no headache. During the follow-up period, the patient had no more TIAs. Conclusion: Endovascular carotid angioplasty stents are an effective and safe way to treat pseudoaneurysm or dissection of the carotid artery, especially in cases presenting with recurrent TIAs and Horner syndrome. The observed clinical improvement following the procedure indicates significant benefits in enhancing the patient's quality of life and preventing complications from recurrent TIA episodes.

Effect of Asymptomatic Common Carotid Artery Dissection on the Prognosis of Patients With Acute Type A Aortic Dissection.

Acute type A aortic dissection can extend upwards to involve the common carotid artery. However, whether asymptomatic common carotid artery dissection (CCAD) requires surgical repair remains controversial. This study aimed to explore the effect of asymptomatic CCAD without surgical intervention on the prognosis of patients who underwent surgery for acute type A aortic dissection. Between January 2015 and December 2017, 485 patients with no neurological symptoms who underwent surgery for acute type A aortic dissection were enrolled in this retrospective cohort study. The patients were divided into 2 groups based on the exposure factor of CCAD. CCAD was detected in 111 patients (22.9%), and after adjusting baseline data (standardized mean difference <0.1), the 30-day mortality (17.1% versus 6.0%, P<0.001) and incidence of fatal stroke (7.7% versus 1.6%, P=0.001) were significantly higher in the group with CCAD. Univariable and multivariable Cox regression analyses found CCAD as an independent risk factor for 30-day mortality (hazard ratio [HR], 2.8 [95% CI, 1.5-5.2]; P=0.001). At a median follow-up of 6.2 years (interquartile range, 5.6-6.9 years), landmark analysis with a cutoff value of 1 month postoperatively showed a significant increase in mortality in the group with CCAD, especially in the first month (log-rank P=0.002) and no significant difference in survival after the first month postoperatively between the 2 groups (log-rank P=0.955). Asymptomatic CCAD increased the risk of early fatal stroke and death in patients with acute type A aortic dissection after surgery but did not affect midterm survival in patients who survived the early postoperative period.

Post-Traumatic Dissection of the Right Common Carotid Artery: A Case Report

Arterial injuries in neck trauma often result in serious consequences that can compromise the patient's vital prognosis. Artery dissection injuries are not uncommon in traumatic events in this region. The diagnosis is based on a combination of clinical signs and confirmed by imaging. The management of neck arterial injuries is now based on algorithms based on the patient's clinical presentation at admission. We report the case of a patient who suffered a penetrating neck injury and whose imaging confirmed a dissection of the common carotid artery with occlusion of the internal carotid artery and for whom surgery was indicated based on clinical and radiologic findings.

Common carotid artery dissection from sportive choking

Tandem occlusions of the anterior circulation refer to the simultaneous presence of a cervical carotid artery occlusion or high-grade stenosis and an ipsilateral large vessel occlusion involving the intracranial internal carotid artery, M1 or proximal M2 middle cerebral artery. Whilst carotid occlusion usually results from progressive atherosclerotic disease, in younger individuals it may arise secondary to a dissection for which there are multiple aetiologies, with trauma being an important cause in patients having a relevant history. We present a rare case of traumatic left common carotid artery dissection in a young professional Jiu-Jitsu fighter presenting with delayed stroke symptoms and angiographic findings of a tandem occlusion. This case was successfully managed with endovascular clot retrieval and antiplatelet medication.

P26 TRANSIENT GLOBAL AMNESIA AS A POSSIBLE CONSEQUENCE OF ICA DISSECTION: A CASE REPORT

Abstract Case Report A 42–year–old woman was carried to emergency room lamenting sudden memory loss. Her husband witnessed the onset of the episode. No recent head trauma was reported, blood pressure was under control. Anterograde and retrograde memory loss was present and confirmed by a neurologist. No other neurological signs were elicitable. Blood exams and toxicological analysis were negative. ECG, chest radiography, and cerebral TC showed no abnormalities. At physical examination a carotid bruit could be appreciated. The patient was asymptomatic. Subsequently an eco–colour–Doppler of carotid artery was performed showing a left common and internal carotid artery dissection. The diagnosis of ICA dissection was confirmed with a contrast CT furthermore excluding the coexistence of an aortic dissection. The anterograde amnesia resolved 15 h after the admission. A neurologist confirmed that the patient experimented an episode of transient global amnesia. After a vascular surgery consultation, a conservative treatment was deemed appropriate. After a 6 month follow up the patient didn’t complain of any other neurological symptom or sign. Transient global amnesia (TGA) is characterized by reversible anterograde and retrograde amnesia of sudden onset that resolves spontaneously within 24 h. The pathophysiological mechanisms underlying this puzzling neurological syndrome are yet not completely clarified. Some studies support an ischemic aetiology for TGA and cases of TGA following ICA–stenting or aortic dissection with involvement of the supra–aortic branches are reported in literature, thus supporting the hypothesis that a cause–effect relationship between ischemic pathologies of supra–aortic trunks and TGA might be present. In the case here presented, a Doppler ultrasound of carotid arteries performed in a patient presenting with TGA, asymptomatic for neck pain, led to a diagnosis of ICA dissection. In order to not miss a spontaneous ICA dissection as a rare ethology of TGA, we suggesto perform an eco–colour–Doppler of the epi–aortic vessels in patients affected by such amnesic syndrome.

Risk prediction of preoperative acute ischemic stroke in acute type A aortic dissection.

To predict preoperative acute ischemic stroke (AIS) in acute type A aortic dissection (ATAAD). In this multi-center retrospective study, 508 consecutive patients diagnosed as ATAAD between April 2020 and March 2021 were considered for inclusion. The patients were divided into a development cohort and two validation cohorts based on time periods and centers. Clinical data and imaging findings obtained were analyzed. Univariable and multivariable logistic regression analyses were performed to identify predictors associated with preoperative AIS. The performance of resulting nomogram was evaluated in discrimination and calibration on all cohorts. A total of 224 patients were in the development cohort, 94 in the temporal validation cohort, and 118 in the geographical validation cohort. Six predictors were identified: age, syncope, D-dimer, moderate to severe aortic valve insufficiency, diameter ratio of true lumen in ascending aorta < 0.33, and common carotid artery dissection. The nomogram established showed good discrimination (area under the receiver operating characteristic curve [AUC], 0.803; 95% CI: 0.742, 0.864) and calibration (Hosmer-Lemeshow test p = 0.300) in the development cohort. External validation showed good discrimination and calibration abilities in both temporal (AUC, 0.778; 95% CI: 0.671, 0.885; Hosmer-Lemeshow test p = 0.161) and geographical cohort (AUC, 0.806; 95% CI: 0.717, 0.895; Hosmer-Lemeshow test p = 0.100). A nomogram, based on simple imaging and clinical variables collected on admission, showed good discrimination and calibration abilities in predicting preoperative AIS for ATAAD patients. • A nomogram based on simple imaging and clinical findings may predict preoperative acute ischemic stroke in patients with acute type A aortic dissection in emergencies. • The nomogram showed good discrimination and calibration abilities in validation cohorts.

Isolated and Spontaneous Common Carotid Artery Dissection: A Case Report (P12-5.024)

Isolated and Spontaneous Common Carotid Artery Dissection: A Case Report (P12-5.024)

Abstract WP135: Trends In The Incidence Of Spontaneous Cervical Artery Dissection

Background: Arterial dissection represents a rare but significant cause of ischemic stroke. We hypothesized that the detection rate of arterial dissections has increased in recent decades. Objective: To determine the incidence of cervical artery dissection in a defined population. Methods: We identified Olmsted County, Minnesota residents diagnosed with carotid artery or vertebral artery dissection between 2002 and 2020 using the Rochester Epidemiology Project database. Patients who had suffered major trauma, were under 18 years of age or had intracranial artery dissections were excluded. Virtually all Olmsted County residents receive their medical care within the participating health systems, leading to a high likelihood of complete case ascertainment. We assessed longitudinal trends by dividing the data into 5-year time windows, with the last being a 4-year interval. Incidence rates were adjusted for age and sex. Results: In a 19-year period from 2002 through 2020, 127 patients with a diagnosis of cervical artery dissection were identified. There were 64 females (50.4%) and 63 males (49.6%). The average age at diagnosis was 51.2 years (SD 15.7). There were 63 internal carotid artery dissections (ICAD), 60 vertebral artery dissections (VAD), and three common carotid artery dissections (CCAD) identified. One patient had ICAD and VAD at diagnosis. The overall incidence rate of detection for cervical artery dissection, adjusted for age and sex, was 4.9 per 100,000 person-years (py) (95% CI, 4.0 to 5.7). The incidence rate of ICAD was 2.5 per 100,000 py (95% CI, 1.8 to 3.1). The incidence rate of VAD was 2.3 per 100,000 py (95% CI, 1.7 to 2.9). The incidence rate of CAD gradually increased over time from 2.3 per 100,000 py (95% CI, 1.1 to 3.5) in 2002-2006 to 9.4 per 100,000 py (95% CI, 6.9 to 11.8) in 2017-2020, a 4.2-fold increase. Conclusion: The incidence of detection rate of cervical artery dissection increased over four-fold in the last 19 years. This can potentially be attributed to increased usage of non-invasive angiographic imaging.

564 AN UNUSUAL PRESENTATION OF ICA DISSECTION. A CASE OF TRANSIENT GLOBAL AMNESIA IN A PATIENT WITH PAINLESS SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION

Abstract Image focus A 42-year-old woman was carried to emergency room lamenting sudden memory loss. Her husband witnessed the onset of the episode. No recent head trauma was reported, blood pressure was under control. Anterograde and retrograde memory loss was present and confirmed by a neurologist. No other neurological signs were elicitable. Blood exams and toxicological analysis were negative. ECG, chest radiography, and cerebral TC showed no abnormalities. At physical examination a carotid bruit could be appreciated. We performed an eco-color-Doppler of carotid artery that showed a left common and internal carotid artery dissection (figure 1). The diagnosis of ICA dissection was confirmed with a contrast CT. The coexistence of an aortic dissection was excluded with the same imaging technique. The anterograde amnesia resolved 15 h after the admission. A neurologist confirmed that the patient experimented an episode of transient global amnesia (TGA). After a vascular surgery consultation, a conservative treatment was deemed appropriate. After a 6 month follow up the patient didn't complain of any other neurological symptom or sign. Transient global amnesia (TGA) is characterized by reversible anterograde and retrograde amnesia of sudden onset. This amnesic syndrome resolves spontaneously within 24 h. Annual incidence rate for all ages of spontaneous ICA dissection is approximately of 2.6 per 100 000 inhabitants, however data are extremely variable among different studies. TGA has never been associated with a spontaneous ICA dissection. In order to not miss a spontaneous ICA dissection as a rare ethology of TGA, we suggest performing an eco-color-Doppler of the epi-aortic vessels in patient affected by such amnesic syndrome.

Acute painless spontaneous common carotid artery dissection related to newly diagnosed HIV infection.

Acute painless spontaneous common carotid artery dissection related to newly diagnosed HIV infection.

Bilateral Common Carotid Artery Dissection Presenting as Delayed Cerebral Ischemia (2624)

Bilateral Common Carotid Artery Dissection Presenting as Delayed Cerebral Ischemia (2624)

Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair.

Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation tothe presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. BCA dissection was an independent risk factor of stroke after ATAAD repair.

Common carotid artery dissection caused by a kendo thrust: A case report

Common carotid artery dissection caused by a kendo thrust: A case report

以脑梗死为首发症状的主动脉、左侧颈总动脉夹层1例

以脑梗死为首发症状的主动脉、左侧颈总动脉夹层1例

Common carotid artery true lumen flow impairment in patients with type A aortic dissection.

Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection. Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded. Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023). Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.

Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access.

While the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access. The authors retrospectively studied patients from their prospective AIS-LVO database who underwent attempted MT between 2015 and 2018. Patients with prohibitive vascular access were divided into two groups: 1) aborted MT (abMT) after failed transfemoral access and 2) attempted MT via DCP. Functional outcome was assessed using the modified Rankin Scale at 3 months. Associations with outcome were analyzed using ordinal logistic regression. Of 352 consecutive patients with anterior circulation AIS-LVO who underwent attempted MT, 37 patients (10.5%) were deemed to have prohibitive vascular access (mean age [± SD] 82 ± 11 years, mean National Institutes of Health Stroke Scale [NIHSS] score 17 ± 5, with females accounting for 75% of the patients). There were 20 patients in the DCP group and 17 in the abMT group. The two groups were well matched for the known predictors of clinical outcome: age, sex, and admission NIHSS score. Direct carotid access was successfully obtained in 19 of 20 patients. Successful reperfusion (thrombolysis in cerebral infarction score 2b or 3) was achieved in 16 (84%) of 19 patients in the DCP group. Carotid access complications included an inability to catheterize the carotid artery in 1 patient, neck hematomas in 4 patients, non-flow-limiting common carotid artery (CCA) dissections in 2 patients, and a delayed, fatal carotid blowout in 1 patient. The neck hematomas and non-flow-limiting CCA dissections did not require any subsequent interventions and remained clinically silent. Compared with the abMT group, patients in the DCP group had smaller infarct volumes (11 vs 48 ml, p = 0.04), a greater reduction in NIHSS score (-4 vs +2.9, p = 0.03), and better functional outcome (shift analysis for 3-month modified Rankin Scale score: adjusted OR 5.2, 95% CI 1.02-24.5; p = 0.048). DCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates, smaller infarct volumes, and improved functional outcome compared with patients with abMT after failed transfemoral access. DCP should be considered in this patient population.

Clinical Usefulness of Common Carotid Artery Dissection in Carotid Ultrasound for the Diagnosis of Asymptomatic Aortic Dissection

Clinical Usefulness of Common Carotid Artery Dissection in Carotid Ultrasound for the Diagnosis of Asymptomatic Aortic Dissection