Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim
Introduction: There is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management. Report: A...
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| Format: | Article |
| Language: | English |
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Elsevier
2018-01-01
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| Series: | EJVES Short Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405655318300318 |
| _version_ | 1818161128279113728 |
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| author | Viviana Manuel Ryan Gouveia e Melo Ruy Fernandes e Fernandes Ana Rita Santos Luís Silvestre Emanuel Silva Tony Soares Luís Mendes Pedro |
| author_facet | Viviana Manuel Ryan Gouveia e Melo Ruy Fernandes e Fernandes Ana Rita Santos Luís Silvestre Emanuel Silva Tony Soares Luís Mendes Pedro |
| author_sort | Viviana Manuel |
| collection | DOAJ |
| description | Introduction: There is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management. Report: A 50 year old male patient was admitted after attempted suicide through hanging, having been swiftly rescued by a bystander. On admission, six hours after the event there was no neurological deficit. There was evidence of soft tissue damage related to the rope position, subcutaneous emphysema, and neck swelling. The CT angiogram showed dissection of both common carotid arteries with significant luminal narrowing as well as fracture of the thyroid cartilage; brain injury was excluded. Heparin infusion was started and an endovascular repair with bilateral covered stent placement, requiring coverage of the external carotid artery on the left side, was performed. The vascular procedure was uneventful. The patient was discharged 36 days after the event, on dual antiplatelet drugs and under regular psychiatric and speech therapy care, and is currently alive and well 22 months after surgery with no neurological damage. Discussion: The choice of treatment was not straightforward as there are no guidelines or consensus around its management. In this case, however, an endovascular repair seemed suitable and the result was optimal, with no neurological damage and a good result after 22 months. Keywords: Carotid blunt injury, Endovascular repair, Near-hanging, carotid dissection |
| first_indexed | 2024-12-11T16:12:51Z |
| format | Article |
| id | doaj.art-acc9522ef4a3497783bf14f2995b1676 |
| institution | Directory Open Access Journal |
| issn | 2405-6553 |
| language | English |
| last_indexed | 2024-12-11T16:12:51Z |
| publishDate | 2018-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Short Reports |
| spelling | doaj.art-acc9522ef4a3497783bf14f2995b16762022-12-22T00:59:02ZengElsevierEJVES Short Reports2405-65532018-01-01402125Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging VictimViviana Manuel0Ryan Gouveia e Melo1Ruy Fernandes e Fernandes2Ana Rita Santos3Luís Silvestre4Emanuel Silva5Tony Soares6Luís Mendes Pedro7Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalVascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Corresponding author. Hospital de Santa Maria – Centro Hospitalar Lisboa Norte, EPE, Serviço de Angiologia e Cirurgia Vascular, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal.Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalEar, Nose & Throat Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalVascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalVascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalVascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalVascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Avenida Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Lisbon Medical Academic Center, Avenida Prof. Egas Moniz, 1649-035 Lisboa, PortugalIntroduction: There is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management. Report: A 50 year old male patient was admitted after attempted suicide through hanging, having been swiftly rescued by a bystander. On admission, six hours after the event there was no neurological deficit. There was evidence of soft tissue damage related to the rope position, subcutaneous emphysema, and neck swelling. The CT angiogram showed dissection of both common carotid arteries with significant luminal narrowing as well as fracture of the thyroid cartilage; brain injury was excluded. Heparin infusion was started and an endovascular repair with bilateral covered stent placement, requiring coverage of the external carotid artery on the left side, was performed. The vascular procedure was uneventful. The patient was discharged 36 days after the event, on dual antiplatelet drugs and under regular psychiatric and speech therapy care, and is currently alive and well 22 months after surgery with no neurological damage. Discussion: The choice of treatment was not straightforward as there are no guidelines or consensus around its management. In this case, however, an endovascular repair seemed suitable and the result was optimal, with no neurological damage and a good result after 22 months. Keywords: Carotid blunt injury, Endovascular repair, Near-hanging, carotid dissectionhttp://www.sciencedirect.com/science/article/pii/S2405655318300318 |
| spellingShingle | Viviana Manuel Ryan Gouveia e Melo Ruy Fernandes e Fernandes Ana Rita Santos Luís Silvestre Emanuel Silva Tony Soares Luís Mendes Pedro Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim EJVES Short Reports |
| title | Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim |
| title_full | Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim |
| title_fullStr | Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim |
| title_full_unstemmed | Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim |
| title_short | Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim |
| title_sort | endovascular repair of bilateral carotid dissection in a near hanging victim |
| url | http://www.sciencedirect.com/science/article/pii/S2405655318300318 |
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