JACC. Case reports · 2026
Bedside Ultrasound-Driven Emergency Stenting for Spontaneous Carotid Artery Dissection: Clinical and Technical Insights.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Terracciano Francesco, Di Lorenzo Daniele, Falato Sergio, Granata Francesco, Scala Pasquale, Rea Rosaria, Maresca Gennaro
Аннотация
BACKGROUND: Spontaneous carotid artery dissection is a leading cause of stroke in young adults. Timely diagnosis and monitoring are crucial as the condition is hemodynamically dynamic.
CASE SUMMARY: A 52-year-old man presented with minor stroke (National Institutes of Health Stroke Scale 3) due to spontaneous carotid artery dissection. Initial imaging showed nonsignificant stenosis, and medical therapy was started. Following sudden neurological deterioration (National Institutes of Health Stroke Scale 15), bedside carotid Doppler ultrasound revealed a critical stenosis caused by a rapidly expanding intramural hematoma. The patient underwent emergent percutaneous stenting with a nitinol self-expandable stent, resulting in immediate clinical improvement and complete symptom resolution at 1 month.
DISCUSSION: While computed tomography angiography is the gold standard for initial diagnosis, its static nature may underestimate evolving lesions. This case highlights how bedside carotid Doppler ultrasound's superior temporal resolution captures dynamic hematoma expansion that angiography might miss, guiding life-saving emergency intervention when medical therapy fails.
TAKE-HOME MESSAGES: Bedside carotid Doppler ultrasound is pivotal for monitoring patients with spontaneous carotid artery dissection, as it detects real-time instability of the intramural hematoma. Emergency stenting is an effective salvage therapy for neurological worsening.
CASE SUMMARY: A 52-year-old man presented with minor stroke (National Institutes of Health Stroke Scale 3) due to spontaneous carotid artery dissection. Initial imaging showed nonsignificant stenosis, and medical therapy was started. Following sudden neurological deterioration (National Institutes of Health Stroke Scale 15), bedside carotid Doppler ultrasound revealed a critical stenosis caused by a rapidly expanding intramural hematoma. The patient underwent emergent percutaneous stenting with a nitinol self-expandable stent, resulting in immediate clinical improvement and complete symptom resolution at 1 month.
DISCUSSION: While computed tomography angiography is the gold standard for initial diagnosis, its static nature may underestimate evolving lesions. This case highlights how bedside carotid Doppler ultrasound's superior temporal resolution captures dynamic hematoma expansion that angiography might miss, guiding life-saving emergency intervention when medical therapy fails.
TAKE-HOME MESSAGES: Bedside carotid Doppler ultrasound is pivotal for monitoring patients with spontaneous carotid artery dissection, as it detects real-time instability of the intramural hematoma. Emergency stenting is an effective salvage therapy for neurological worsening.