Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 10033-10039
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.10033
Focal intramural hematoma as a potential pitfall for iatrogenic aortic dissection during subclavian artery stenting: A case report
Yu Zhang, Jun-Wei Wang, Ge Jin, Bo Liang, Xin Li, Yong-Tao Yang, Qun-Ling Zhan
Yu Zhang, Department of Interventional Radiology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
Jun-Wei Wang, Ge Jin, Bo Liang, Xin Li, Yong-Tao Yang, Qun-Ling Zhan, Department of Neurology, The Fifth People’s Hospital of Chongqing, Chongqing 400062, China
Author contributions: Jin G was responsible for the literature consult and study design; Liang B was responsible for acquisition of clinical data; Zhang Y and Wang JW contributed to the drafting of the manuscript; Li X and Yang YT were responsible for editing the figures; Jin G and Zhan QL contributed to the critical revision of the manuscript; All authors were responsible for analysis and interpretation of the data, and final approval of this manuscript.
Supported by the Medical Research Project of Chongqing Health Commission, NO. 2015MSXM113.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ge Jin, MD, PhD, Doctor, Department of Neurology, The Fifth People’s Hospital of Chongqing, No. 24 Renji Road, Nanan District, Chongqing 400062, China. wysnjg@163.com
Received: July 6, 2021
Peer-review started: July 6, 2021
First decision: July 26, 2021
Revised: August 8, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 16, 2021
Processing time: 126 Days and 16.3 Hours
Abstract
BACKGROUND

Iatrogenic aortic dissection (IAD) is a rare but fatal complication of interventional treatment for the proximal supra-aortic large vessels. Several cases of IAD after endovascular treatment of subclavian artery have been reported. Nevertheless, the pathogenesis of IAD is still unclear. Here we report a patient with IAD following a balloon expandable stent implanted into the left subclavian artery (LSA).

CASE SUMMARY

An 84-year-old man with a history of hypertension was admitted to the Neurology Department of our hospital complaining of dizziness and gait disturbance for more than 1 mo. Computed tomography angiography of the head and neck showed severe stenosis at the proximal LSA and the origin of the left vertebral artery. Magnetic resonance diffusion-weighted imaging of the brain revealed subacute infarctions in cerebellum, occipital lobe and medulla oblongata. He suffered a Stanford type B aortic dissection after the proximal LSA angioplasty with a balloon expandable stent. Thoracic endovascular aortic repair was performed immediately with the chimney technique and he was discharged 20 d later. After exploring the pathogenesis with multimodal imaging analysis, an easily neglected focal intramural hematoma (IMH) in the aorta near the junction of the LSA was found to be the main cause of the IAD. The risk of IAD should be sufficiently evaluated according to the characteristics of aortic arch lesions before the proximal LSA angioplasty.

CONCLUSION

Focal aortic IMH is a potential risk factor for IAD during a seemingly simple stenting of the proximal LSA.

Keywords: Intramural hematoma; Subclavian artery stenting; Iatrogenic aortic dissection; Case report

Core Tip: Iatrogenic aortic dissection (IAD) is a rare complication during angioplasty or stenting for the proximal left subclavian artery (LSA) stenosis. The authors present an 84-year-old patient with posterior circulation stroke who suffered an aortic dissection immediately after proximal LSA stenting and achieved a favorable outcome following active treatment. The easily neglected focal intramural hematoma is a potential risk factor for IAD in this procedure. The characteristics of aortic arch lesions should be sufficiently evaluated with multimodal imaging analysis before the proximal LSA angioplasty to avoid the occurrence of such event.