Abstract Details

Title Triple Threat: Aorta, Carotid, and Pericardium in Acute Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-018

Objective Not applicable

Background Type A Aortic Artery Dissection (TAAD) represents one of the most lethal cardiovascular emergencies, with mortality rising 1–2% per hour in the first 48 hours if untreated. Neurological complications occur in up to 40%, most commonly ischemic stroke. While acute bilateral carotid involvement is rare, it is often associated with a poor prognosis due to cerebral hypoperfusion and therapeutic limitations. Pericardial effusion, present in 20 - 40% of TAAD, often signals impending rupture, further complicating management.

Design/Methods A 52-year-old woman with end-stage renal disease on hemodialysis, chronic pericarditis with effusion, heart failure with reduced ejection fraction, abdominal aortic aneurysm, and thrombocytopenia of 36 K/uL presented with chest pain, dyspnea, and fever. The patient was under evaluation due to concern for worsening pericardial effusion, when she developed sudden right hemiplegia, left gaze deviation, and decreased responsiveness. Imaging revealed Stanford Type A dissection extending into bilateral carotid arteries, with a left internal carotid artery occlusion and a left MCA territory infarct. The ascending aorta measured a dissection of 4.7 cm with impending rupture, moderate pericardial effusion, and a dilated descending thoracic aorta of 3.1 cm. Given bilateral carotid involvement, rupture risk, and comorbidities, neither neurovascular intervention nor emergent cardiothoracic surgery was pursued.

Results Not applicable

Conclusions

This case highlights overlap of TAAD, bilateral carotid dissection, and pericardial effusion. Intervention was not pursued due to anatomical complexity and pre-existing medical conditions. Multimodal imaging played a crucial role in establishing vascular pathology and assessing tissue viability, thereby guiding critical yet limited management decisions. A high degree of clinical suspicion aimed at improving interdisciplinary efficiency is fundamental in this patient population as rapid decompensation could be imminent.

Authors/Disclosures
Luis R. Navedo-Sanchez, MD (Penn State Health) PRESENTER	Dr. Navedo-Sanchez has nothing to disclose.
Michael I. Nsaka, MD, PhD (Penn State Neuroscience Institute)	Dr. Nsaka has nothing to disclose.
Yatin Srinivash Ramesh Babu	Mr. Ramesh Babu has nothing to disclose.
Gloriel Flores-Caban, MD (Penn State University, Milton S Hershey Medical Center)	Dr. Flores-Caban has nothing to disclose.
Grant W. Zeigler, DO (Penn State Hershey Medical Center)	Dr. Zeigler has nothing to disclose.

��ɫ��

��ɫ��