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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Timely Carotid Revascularization to Prevent Stroke After Left Common Carotid Artery Occlusion During TEVAR
1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Background:
Proximal thoracic endovascular aortic repair extension near the aortic arch may compromise supra-aortic branch perfusion.
Case Summary:
A 41-year-old man with acute Stanford type B/DeBakey III aortic dissection had persistent chest pain despite anti-impulse therapy. A persistent type IA endoleak after the first thoracic stent graft required a second proximal extension. Completion angiography showed resolution of the endoleak but immediate loss of left common carotid artery opacification. Carotid duplex ultrasonography confirmed absent flow. Ultrasound-guided direct left common carotid artery access followed by chimney stenting restored antegrade carotid flow within 10 minutes, before any neurologic deficits developed.
Discussion:
Immediate recognition and rapid bailout revascularization can prevent disabling cerebral ischemia after inadvertent left common carotid artery compromise.
Take-Home Message:
Supra-aortic branch patency should be confirmed after proximal thoracic endovascular aortic repair extension, with prompt carotid bailout when compromise is detected.
