Neurological Surgery No Shinkei Geka Volume 28, Issue 11 (November 2000)

Common Carotid Artery Dissection Propagated from Acute Aortic Dissection : A Case Successfully Treated by PTA Tsukasa KUBOTA 1,2 , Jun NIWA 1 , Masahiko CHIBA 1 , Takeshi MIKAMI 1 , Shinichi OKA 1 1Department of Neurosurgery, Hakodate Municipal Hospital 2Department of Neurosurgery, Hokkaido Social Work Association Obihiro Hospital Keyword: acute aortic dissection , common carotid artery dissection , PTA pp.1015-1021
Published Date 2000/11/10
  • Abstract
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We reported a rare case, which was successfully treated by PTA, of right common carotid artery dissec-tion propagated from acute aortic dissection (AAD) type A.

A 45-year-old male with a past history of hypertension and an artificial graft replacement of the abdomi-nal aorta due to AAD type B, 7 years ago, was brought into our hospital by ambulance 30 minutes after an attack of fainting and left hemiparesis. On admission, the patient complained not.of chest pain or left hemi-paresis, but nausea. At that time his consciousness level was JCS 1. During examinations, he had the same attack twice and his consciousness level deteriorated to JCS 2. Brain MRI showed no abnormality, but cer-vical MRA did not visualize the right carotid artery and thoracic CT depicted acute aortic dissection in-cluding branches of the aorta. Emergent angiography disclosed that the dissecting 99% stenosis of the right common carotid artery had developed from AAD type A with poor collateral blood flow. PTA was carried out 8 times and reduced the residual stenosis to about 50% with shortened circulation time. The patient's consciousness disturbance improved. After the replacement of the whole aortic arch in an artificial graft, the residual stenosis disappeared. The patient recovered without neurological deficit but right frontal silent embolic infarction caused by the artificial graft replacement was detected.

AAD is a catastrophic illness and sometimes accompanied by devastating ischemic cerebral disease (ICD) because of propagation of dissecting to extracranial vessels. This is the first report that shows the efficacy of PTA for treatment of ICD associated with AAD.

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Neurological Surgery 脳神経外科
28巻11号 (2000年11月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院