Direct Neck Exposure for Rescue Endovascular Mechanical Thrombectomy in a Patient with Acute Common Carotid Occlusion Concurrent with Type A Aortic Dissection.

BACKGROUND: Mechanical thrombectomy is an effective management for acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be less than optimal. Herein, we presented a patient with right common carotid artery and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed.

CASE DESCRIPTION: A 45-year-old male had a type A aortic dissection that presented with sudden onset neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of the ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After the aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right common carotid artery (CCA) occlusion up to the internal carotid artery (ICA). The right CCA was exposed and directly punctured. A thrombus was successfully removed, and a total of 5 stents were deployed to treat the ICA and CCA dissection. Angiography showed a final TICI 3 result, and the patient had excellent clinically recovery.

CONCLUSIONS: Acute mechanical thrombectomy through open direct neck puncture due to an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.