PMC9433797_01
Preoperative head and neck magnetic resonance angiography (MRA), three-dimensional reconstruction of head and neck MRA, and blood flow assessment. A dissection at the origin of the left internal carotid artery was observed, and the left internal carotid artery was severely stenosed (A-C). Stenosis at the origin of the left internal carotid artery was associated with an intermural hematoma (C). The right internal carotid, bilateral middle, and anterior cerebral arteries showed no apparent thickening, stenosis, or signal loss (D-F). The bilateral vertebral, basilar, posterior cerebral arteries and their branches were clearly displayed, with no obvious thickening and stenosis (E,F). The bilateral posterior communicating arteries were found opened (D). Blood flow assessment: arterial spin labeling (ASL) revealed a basic symmetry of cerebral blood flow in both cerebral hemispheres.
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In addition, head and neck magnetic resonance angiography (MRA) and computed tomography angiogram (CTA) revealed dissection and severe stenosis in the left internal carotid artery (Figures 1, 2).
(A-F) Preoperative head and neck computed tomography angiogram (CTA) and three-dimensional reconstruction of head and neck CTA. Head and neck CTA showed dissection and severe stenosis at the origin of the left internal carotid artery.
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In addition, head and neck magnetic resonance angiography (MRA) and computed tomography angiogram (CTA) revealed dissection and severe stenosis in the left internal carotid artery (Figures 1, 2).
(A-D) Surgical procedure. The surgical procedure consisted of left carotid artery dissection resection, autologous great saphenous vein interposition grafting, and simple mastoidectomy.
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After the layer-by-layer incision, the left external and common carotid arteries were exposed, and vessel loops were placed as controls (Figure 3A). In addition to the carotid artery, the ansa cervicalis and the vagus nerve were carefully dissociated and protected (Figure 3B). Blue-purple changes of about 3 cm in length were observed on the surface of the initial segment of the left internal carotid artery, with the weak pulsation of the left internal carotid artery (Figure 3A). After exposing the internal carotid artery at the distal end of the styloid process, the boundary between the normal blood vessel and the diseased internal carotid artery could be identified (Figure 3B). After systemic heparinization with 5,000 units of heparin, the left common carotid artery, the external carotid artery, and the distal end of the internal carotid artery were blocked to establish bypass (Figure 3C). After performing longitudinal dissection of the lesion segment of the internal carotid artery, we observed arterial dissection, thrombus in the false lumen, complete occlusion of a part of the true lumen, and unclear intimal structure (Figure 3C). After withdrawing the bypass tube, the left common carotid artery and internal carotid artery were blocked, and the common carotid artery-great saphenous vein anastomosis was performed using a CV-6 suture (Figure 3D).
(A-F) Postoperative head and neck MRA, three-dimensional reconstruction of head and neck MRA, and blood flow assessment. After surgery, head and neck MRA showed recanalization of the left internal carotid artery.
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Postoperative head and neck MRA of the patient showed recanalization of the left internal carotid artery (Figure 4).