Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200243
Jornal Vascular Brasileiro
Case Report

Symptomatic internal carotid artery dissection and kinking in a patient with fibromuscular dysplasia

Dissecção e acotovelamento sintomáticos da artéria carótida interna em paciente com displasia fibromuscular

Victor Bilman; Luca Apruzzi; Domenico Baccellieri; Francesca Sanvito; Luca Bertoglio; Roberto Chiesa

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Abstract

Abstract: Isolated dissection of the internal carotid artery (ICA) is rare in young patients and is a cause for strong suspicion of fibromuscular dysplasia (FMD), especially when associated with artery elongation and tortuosity. The natural history of cerebrovascular FMD is unknown and management of symptomatic patients can be challenging. We report the case of a 44-year-old female patient with a history of transient ischemic attack in the absence of cardiovascular risk factors, associated with an isolated left ICA dissection and kinking. Carotid duplex ultrasound confirmed the diagnosis of dissection and demonstrated severe stenosis of the left ICA. The patient underwent surgical repair and histopathological evaluation confirmed the diagnosis of FMD with dissection. An autogenous great saphenous vein bypass was performed and the patient had an uneventful recovery. Cervical carotid artery dissection can be related to underlying arterial pathologies such as FMD, and the presence of ICA tortuosity highlights certain peculiarities for optimal management, which might be surgical.

Keywords

carotid artery, kinking, coiling, arterial dissection, fibromuscular dysplasia

Resumo

Resumo: A dissecção isolada da artéria carótida interna em pacientes jovens é rara, e a displasia fibromuscular deve ser altamente suspeitada principalmente quando estiver associada a alongamento e tortuosidade da artéria. A história natural da displasia fibromuscular cerebrovascular é desconhecida, e o manejo de pacientes sintomáticos pode ser desafiador. Apresentamos o caso de uma paciente de 44 anos com histórico de ataque isquêmico transitório sem fatores de risco cardiovasculares, associado a dissecção e acotovelamento isolados da artéria carótida interna esquerda. O ultrassom duplo das carótidas confirmou o diagnóstico de dissecção e demonstrou estenose grave na artéria carótida interna esquerda. A paciente foi submetida a reparo cirúrgico, e a avaliação histopatológica confirmou o diagnóstico de displasia fibromuscular com dissecção. Foi realizada cirurgia de ressecção do segmento e reconstrução com veia safena magna autógena, e a paciente se recuperou sem complicações. A dissecção da artéria carótida cervical pode estar relacionada a doenças arteriais subjacentes, como a displasia fibromuscular, e a presença da tortuosidade da artéria carótida interna destaca algumas particularidades no manejo ideal, o qual pode ser cirúrgico.
 

Palavras-chave

artéria carótida, acotovelamento, enrolamento, dissecção arterial, displasia fibromuscular

References

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Submitted date:
12/22/2020

Accepted date:
02/25/2021

60b0e507a9539537c377a092 jvb Articles
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