Carotid Ultrasonography Can Identify Stroke Patients Ineligible for Intravenous Thrombolysis Therapy due to Acute Aortic Dissection

J Neuroimaging. 2015 Jul-Aug;25(4):671-3. doi: 10.1111/jon.12186. Epub 2014 Dec 16.

Abstract

Acute aortic dissection is the most common acute aortic condition requiring urgent surgical therapy. Due to lack of typical symptoms, it is sometimes difficult to identify acute aortic dissection causing ischemic stroke. We report a case of a patient with acute ischemic stroke who was deemed ineligible for intravenous recombinant tissue plasminogen activator treatment based on a finding of acute aortic dissection detected by carotid ultrasonography. After urgent aortic replacement surgery, the patient recovered with no neurological deficit. This case underscores the crucial role of carotid ultrasonography for the investigation of possible underlying acute aortic dissection when considering the use of intravenous recombinant tissue plasminogen activator therapy for hyperacute stroke.

Keywords: Acute stroke; aortic dissection; carotid ultrasound; recombinant tissue plasminogen activator.

MeSH terms

  • Aortic Aneurysm / complications
  • Aortic Aneurysm / diagnostic imaging*
  • Aortic Aneurysm / drug therapy
  • Aortic Dissection / complications
  • Aortic Dissection / diagnostic imaging*
  • Aortic Dissection / drug therapy*
  • Carotid Arteries / diagnostic imaging*
  • Diagnosis, Differential
  • Eligibility Determination
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Prognosis
  • Stroke / diagnostic imaging*
  • Stroke / drug therapy*
  • Stroke / etiology
  • Stroke / surgery
  • Thrombolytic Therapy / methods
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome
  • Ultrasonography / methods

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator