An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

Abstract

We present a rare case of continuous, extensive aortic dissection (AD) involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke. Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

Transient binocular blindness: A rare presentation of aortic dissection

“…5 The percentage of extensive AD involving carotid arteries has not been documented; however, there is literature on the condition. 6…”

Extrakranielle Farbduplexsonografie hirnversorgender Arterien

“…15). Es finden sich in der ACC zwei durchströmte Lumina mit unterschiedlichem Strömungssignal, nicht selten ist die Strömung im "falschen" Lumen auch retrograd (34,35). Zwischen den beiden Lumina bewegt sich pulssynchron die dissezierte Intimamembran, die distal in der ACC oder der Bifurkation eine Öffnung aufweist, durch die die Blutströmung in beiden Lumina kommuniziert.…”

Aortic Dissection as the Culprit for Seizure

“…Aortic dissection affects 5-30 patients per 1,000,000 every year with a high mortality rate [ 1 ]. It occurs when there is a tear in the intima of the aorta, which causes the blood flowing throughout the body to split the layers of the aorta apart [ 2 ]. This leads to a “false lumen” that is created between the aortic intima and the media or adventitia [ 3 ].…”

“…This leads to a “false lumen” that is created between the aortic intima and the media or adventitia [ 3 ]. This can further progress both proximally and distally from the initial point of tear, which can further lead to tissue ischemia, intravascular volume loss, cardiac tamponade, myocardial infarction, and aortic regurgitation [ 2 ].…”

“…There are two different classifications of aortic dissection, the most common one being the Stanford classification [ 2 ]. Stanford type A involves any dissection of the ascending aorta, and type B involves a dissection that does not include the ascending aorta [ 2 ]. In terms of management, type A dissections are surgical emergencies and type B aortic dissections are medically managed [ 2 ].…”