PMC6174822_01
(A) Pre-operative picture showing soft tissue damage and subcutaneous emphysema, neck swelling, and a horizontal abrasion coincident with the rope position. (B) Pre-operative CT angiography showing subcutaneous emphysema and soft tissue swelling.
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On initial assessment, there was soft tissue damage and subcutaneous emphysema, neck swelling, and a horizontal abrasion coincident with the rope position (Fig. 1A and B). The CT angiogram showed bilateral contusion and dissection of the common carotid arteries (CCA) with a degree of luminal narrowing measured by CT angiogram of 70% on the right and 80% on the left (Figure 1, Figure 2A-C), as well as fracture of the thyroid cartilage; there were no acute findings in the vertebral arteries or cervical spine and brain injury was excluded.
(A) Pre-operative CT angiography showing bilateral contusion and dissection of the CCAs with a high degree of luminal narrowing. (B) Pre-operative CT angiography of the right carotid bifurcation. (C) Pre-operative CT angiography of the left carotid bifurcation.
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The CT angiogram showed bilateral contusion and dissection of the common carotid arteries (CCA) with a degree of luminal narrowing measured by CT angiogram of 70% on the right and 80% on the left (Figure 1, Figure 2A-C), as well as fracture of the thyroid cartilage; there were no acute findings in the vertebral arteries or cervical spine and brain injury was excluded.
(A) Intra-operative angiography showing right CCA dissection. (B) Confirmation angiogram after stent placement.
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On the right side, an 8 x 38 mm covered balloon expandable stent (Advanta V12, Atrium Medical Corporation, Hudson, NH, USA) was then placed in the distal two thirds of the CCA (Fig. 3A and B).
(A) Intra-operative angiography showing left CCA dissection extending into the internal carotid artery. (B) Confirmation angiogram after stent placement with coverage and exclusion of the external carotid artery.
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On the left side, however, because of the extent of the dissection which prolapsed into the ICA (Fig. 4A), an 8 x 59 mm covered balloon expandable stent (Advanta V12, Atrium Medical Corporation) was placed in the CCA extending to the ICA, thus excluding the ECA (Fig. 4B).
(A) Anterior view of post-operative 3D CT angiogram. (B) Left lateral view of post-operative 3D CT angiogram.
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The control CT angiogram showed an optimal result with no complications (Fig. 5A and B) and the patient is alive and well 22 months after surgery with complete recovery of his speech.