Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Endovascular recanalization therapy for patients with acute ischemic stroke with hidden aortic dissection: A case series

  • Hye Seon Jeong (Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital) ;
  • Eun-Oh Jeong (Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital) ;
  • In Young Lee (Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital) ;
  • Hak In Lee (Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital) ;
  • Hyeon-Song Koh (Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital) ;
  • Hyon-Jo Kwon (Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital)
  • Received : 2022.06.29
  • Accepted : 2022.11.07
  • Published : 2023.09.30
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Abstract

Aortic dissection is one of the causes of acute ischemic stroke. Endovascular recanalization therapy (EVT) has emerged as an essential treatment for acute ischemic stroke due to large artery occlusion. However, it is rarely performed in the situation of hidden aortic dissection (AD). Two patients presented to the emergency room with focal neurologic deficits. The first patient was diagnosed with right internal carotid artery (ICA) occlusion. Angiography revealed that the ICA was occluded by the dissection flap. After a stent deployment in the proximal ICA, the antegrade flow was restored. The patient was diagnosed with AD on chest computed tomography (CT) after EVT. For the second patient, intraarterial thrombectomy was performed to treat left middle cerebral artery occlusion. AD was first detected on echocardiography, which was performed after EVT. Herein, we report successful endovascular recanalization therapy performed in two patients with acute ischemic stroke in the situation of undiagnosed aortic dissection. We also reviewed previous case reports and relevant literature.

Keywords

Acknowledgement

This study was supported by grants from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A6A1029617).

References

  1. Funakoshi Y, Imamura H, Tokunaga S, Murakami Y, Tani S, Adachi H, et al. Carotid artery stenting before surgery for carotid artery occlusion associated with acute type A aortic dissection: two case reports. Interv Neuroradiol. 2020 Dec;26(6):814-20.
  2. Grupper M, Eran A, Shifrin A. Ischemic stroke, aortic dissection, and thrombolytic therapy-the importance of basic clinical skills. J Gen Intern Med. 2007 Sep;22(9):1370-2.
  3. Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM, et al. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013 May;127(20):2031-7.
  4. Koga M, Iguchi Y, Ohara T, Tahara Y, Fukuda T, Noguchi T, et al. Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis. Gen Thorac Cardiovasc Surg. 2018 Aug;66(8):439-45.
  5. Lee JY, Park JH, Jeon HJ, Yoon DY, Park SW, Cho BM. Transcervical access via direct neck exposure for neurointerventional procedures in the hybrid angiosuite. Neuroradiology. 2018 May;60(5):565-73.
  6. Lu C, Lin Y, Chu H, Tang S, Lee C. Safety and efficacy of the transbrachial approach for endovascular thrombectomy in patients with acute large vessel occlusion stroke. J Formos Med Assoc. 2021 Jan;120(1 Pt 3):705-12.
  7. Mendes A, Mendonca T, Sousa A, Moreira G, Carvalho M. Stroke secondary to aortic dissection treated with a thrombolytic: a successful case. Neurol Sci. 2012 Feb;33(1):107-10.
  8. Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000 May;117(5):1271-8.
  9. Reznik ME, Espinosa-Morales AD, Jumaa MA, Zaidi S, Ducruet AF, Jadhav AP. Endovascular thrombectomy in the setting of aortic dissection. J Neurointerv Surg. 2017 Jan;9(1):17-20.
  10. Sakamoto Y, Koga M, Ohara T, Ohyama S, Matsubara S, Minatoya K, et al. Frequency and detection of Stanford type a aortic dissection in hyperacute stroke management. Cerebrovasc Dis. 2016;42(1-2):110-6.