Carotid artery stenting before surgery for carotid artery occlusion associated with acute type A aortic dissection: Two case reports

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> We experienced two cases of ischemic stroke resulting from carotid artery occlusion associated with acute type A aortic dissection (ATAAD), in which carotid artery stenting before the surgery for ATAAD resulted in good clinical outcomes. Case 1 description: A 63-year-old woman was hospitalized for conscious disturbance, right hemiparesis, and total aphasia. Computed tomography of the head showed no abnormal findings. Computed tomography angiography showed ATAAD and bilateral common carotid artery occlusion. Surgery was not indicated for ATAAD because of a poor prognosis of ischemic stroke. However, carotid artery stenting of the left common carotid artery occlusion was successfully performed, and her neurological findings improved. The patient underwent hemiarch replacement for ATAAD on the day after carotid artery stenting. Her final modified Rankin Scale was 1. Case 2 Description: A 57-year-old woman was hospitalized for mild left hemiparesis. Magnetic resonance imaging showed right watershed infarction and right common carotid artery occlusion. Computed tomography angiography showed ATAAD. After hospitalization, conscious disturbance appeared and left hemiparesis worsened. Ischemic stroke indicated a poor prognosis for revascularization by surgery for ATAAD. Thus, carotid artery stenting of the right common carotid artery occlusion was performed. The patient’s neurological findings improved and she underwent hemiarch replacement for ATAAD at 19 days after carotid artery stenting. Her final modified Rankin Scale was 1. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> In the present cases, although ischemic stroke was serious and precluded surgical indication for ATAAD, carotid artery stenting before surgery for ATAAD resulted in good clinical outcomes. Performing carotid artery stenting before surgery for ATAAD is challenging but achievable, and is a valid treatment option depending on the individual cases. </jats:p></jats:sec>

Endovascular recanalization therapy for patients with acute ischemic stroke with hidden aortic dissection: A case series

“…In another case involving CCA origin, three stents were deployed from the ICA to the origin of CCA to cover the entry tear. 1) In our first case, the dissection flap from the innominate artery origin to mid-CCA was, fortunately, not significant. Therefore, the compromised right ICA flow was restored by the deployment of only one stent from the distal CCA to the proximal ICA.…”

Stenting in Brain Hemodynamic Injury of Carotid Origin Caused by Type A Aortic Dissection: Local Experience and Systematic Literature Review

“…Patients had a median age of 64.5 years (IQR 57–70) for the case reports [ 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], and 60.5 years and 68 years in the cohorts [ 12 , 17 ]; 52% were female. A history of arterial hypertension (AH) was found in 83% of the cases.…”

“…In the context of AAD extended to the carotid arteries, a limited number of case reports have been published in the literature, with stenting before [ 14 , 26 , 27 ], during [ 31 , 33 , 34 ], or after [ 11 , 21 , 28 , 34 , 35 , 36 , 37 , 38 ] aortic surgical repair: in all reported cases, technical success was achieved, with complete exclusion of false lumen, and stent patency at follow-up. All patients showed improvement or complete resolution of neurological symptoms.…”

Type A Acute Aortic Dissection Presenting With Cerebrovascular Accident at Advanced Age

“…Other groups have reported direct surgical fenestration of the carotid artery, intra-operative carotid stenting, and percutaneous carotid stenting before the initiation of surgical repair, with favorable neurological outcomes. [26][27][28][29][30] The role of cerebral perfusion during HCA has been extensively discussed. In the present analysis, cerebral perfusion was utilized more commonly in patients presenting with CVA (94.9% versus 81.8%, p = 0.036) (Supplementary Table 2).…”