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Left, Then Right Internal Carotid Artery Dissection: A Case Report
Jeffrey M Kalczynski1, John Douds2, Michael E Silverman1
1Morristown Medical College, Department of Emergency Medicine, Morristown, New Jersey.
Insights
A patient experienced bilateral internal carotid artery dissections (ICAD), requiring two thrombectomies. Prompt neurological monitoring and AI-assisted diagnosis were crucial for a positive outcome in this rare case.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- A unique case of spontaneous internal carotid artery dissection (ICAD) presenting with stroke-like symptoms.
- Initial presentation involved a left-sided ICAD successfully treated with thrombectomy.
Observation:
- The patient subsequently developed contralateral symptoms due to a right-sided ICAD.
- A second, contralateral thrombectomy was performed to manage the new symptoms.
- Hypotension was noted, potentially due to bilateral carotid baroreceptor trauma.
Findings:
- Bilateral ICAD is a rare complication following initial dissection and treatment.
- Close neurological monitoring is essential during and after interventions like thrombectomy.
- Artificial intelligence (AI) software can expedite the indication for thrombectomy.
Implications:
- This case underscores the critical need for vigilant neurological monitoring in a specialized setting post-intervention.
- Timely identification of contralateral symptoms significantly impacts patient outcomes.
- AI in neuroimaging holds promise for improving the speed and accuracy of stroke treatment decisions.
Introduction:
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).
Case Report:
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.
Conclusion:
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.
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