Transcarotid Artery Revascularization (TCAR): The Best Surgical Intervention Option in an Unusual Presentation of Carotid Dissection in a 37-Year-Old Pregnant Female

TL;DR

A 37-year-old pregnant woman with a rare carotid artery dissection was successfully treated with transcarotid artery revascularization.

Contribution

This case highlights TCAR as a novel and effective surgical option for treating carotid dissection in a pregnant patient.

Findings

Right internal carotid artery dissection with >70% stenosis and thrombus was diagnosed in a pregnant patient.

Transcarotid artery revascularization was selected as the optimal treatment after comparing multiple surgical options.

Abstract

Carotid artery dissection (CAD) is a condition that compromises blood flow and leads to serious complications such as a stroke or cerebrovascular accident (CVA). This case report demonstrates an unusual case of right internal carotid artery dissection, stenosis of >70%, and an intraluminal thrombus. The patient presented to the emergency department with complaints of right-sided neck pain and severe headache status-post a complicated pregnancy. A computed tomography (CT) angiogram of the right carotid was conducted and showed a right internal carotid artery dissection with 70% luminal stenosis and thrombosis. Carotid endarterectomy (CEA), transfemoral carotid angioplasty with stenting (CAS), or transcarotid artery revascularization (TCAR) were all surgical intervention options that were explored. Risks and benefits were compared between the three surgical intervention options, and transcarotid artery revascularization was deemed the best surgical option in this patient's case.

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