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

Chuan-Min Lin; Chien-Hung Chang; Shao-Wei Chen; Yu-Hsuan Huang; Alvin Yi-Chou Wang; Ching-Chang Chen

doi:10.1016/j.wneu.2019.01.081

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

World Neurosurg. 2019 Apr:124:361-365. doi: 10.1016/j.wneu.2019.01.081. Epub 2019 Jan 28.

Authors

Chuan-Min Lin¹, Chien-Hung Chang¹, Shao-Wei Chen², Yu-Hsuan Huang³, Alvin Yi-Chou Wang⁴, Ching-Chang Chen⁵

Affiliations

¹ Stroke Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
² Division of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
³ Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan.
⁴ Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
⁵ Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. Electronic address: 8702047@cgmh.org.tw.

PMID: 30703603
DOI: 10.1016/j.wneu.2019.01.081

Abstract

Background: 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.

Case description: 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.

Conclusions: 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.

Keywords: Carotid dissection; Hybrid angiography suite; Mechanical thrombectomy; Neck exposure; Type A aortic dissection.