Left, Then Right Internal Carotid Artery Dissection: A Case Report

We present a unique case of a patient who presented to the emergency department with stroke-like symptoms found to have a spontaneous, left-sided internal carotid artery dissection (ICAD).

The patient was treated successfully with thrombectomy and subsequently developed contralateral symptoms caused by a right-sided ICAD. This was managed with a second contra-lateral thrombectomy. The patient's course was complicated by persistent and mild hypotension, postulated to be secondary to bilateral carotid baroreceptor trauma from the dissections.

This case highlights the importance of close neurological monitoring for patients, preferably in a neurologic critical care setting, during and after invasive treatments such as systemic thrombolytic administration or mechanical thrombectomy. In this case, identifying the patient's subsequent development of contralateral symptoms in a timely fashion was key to his positive outcome. An additional factor that had a positive impact on this outcome was the use of artificial intelligence software, which assists in determining whether thrombectomy may be indicated prior to receiving a formal radiologist read on computed tomography angiography/perfusion studies. Artificial intelligence technology such as this has great potential to augment and expedite patient care.