Dissection and intussusception of the common carotid artery following endarterectomy

We describe a 67-year-old man who developed a dissection of the right common carotid arterial wall with intussusception two years following endarterectomy for atherosclerosis. We suggest that the previous surgical procedure resulted in a thinned and weakened media. With a disruption of the intima, a dissection into the inner third of the media formed, and blood in the false lumen buckled the intima into the lumen of the blood vessel. Hemodynamic forces then probably played a role in the propagation of the dissection and the formation of an intussusception. Complete occlusion by thrombus followed, resulting in a massive cerebral infarct, the likely terminal event. Carotid endarterectomy rarely may be followed by dissection of the vascular wall and intussusception.