Multidetector CT angiography influences the choice of treatment for blunt carotid artery injury

Abstract

A 43-year-old woman presented with a 2 h history of left neck pain after striking her neck against a marble bench while playing with her son. The patient was screened for blunt cerebrovascular injury (BCVI) and a left carotid bruit was identified. Subsequently, she underwent multidetector CT angiography (MCTA) of the aortic arch and neck vessels, which demonstrated a flow-limiting dissection of the left common carotid artery (CCA). The patient was started on heparin infusion and underwent an emergency operation. At surgery, a circumferential intimal dissection was excised and the arteriotomy defect closed with an autologous venous patch. This case emphasises the importance of adequately examining patients with direct injury to the neck, screening relevant patients for BCVI and investigating them with MCTA that influences the choice of a treatment option.

Figure 1

Multidetector CT angiography showed the left common carotid artery dissection with proximal (a small arrow) and distal dissection flaps (a large arrow).

Figure 2

A reconstructed three-dimensional CT angiography demonstrated a dissection of the left common carotid artery at 1.5 cm proximal to the carotid bifurcation (an arrow).

Figure 3

The left common carotid artery exploration revealed an intimal dissection with a long distal dissection flap nearly occluding the lumen of the artery.