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

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 co...

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Bibliographic Details
Main Authors: Jeffrey M. Kalczynski, John Douds, Michael E. Silverman
Format: Article
Language:English
Published: eScholarship Publishing, University of California 2024-10-01
Series:Clinical Practice and Cases in Emergency Medicine
Online Access:https://escholarship.org/uc/item/5fr4n7pg
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Summary: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.
ISSN:2474-252X