Tanısal Karotis Görüntüleme Esnasında Asendan Aort Diseksiyonunu Gelişmesi ve Yönetimi
Özet
Tanısal karotis görüntüleme esnasında Asendan Aort Diseksiyonunu gelişmesi literatürde nadir ancak hayati öneme sahip klinik senaryolardan biridir. Bu çalışmada 69 yaşında erkek hasta trans iskemik atak geçirmesi üzerine tanısal görüntüleme işlemi yapıldı. Karotis anjiyografi görüntülemesinde sağ ICA'da %80 civarında anlamlı darlığa neden olan damar düzensizlikleri izlenmiş olup karotis stentleme işlemine geçildi. İşlem öncesi ani başlayan, bıçak saplanır tarzda şiddetli göğüs ağrısı tariflemesi üzerine sırasıyla elektorkardiyografisi, transtorasik ekokardiyografi ve Toraks BT anjiyografi ile değerlendirilmesi yapılmıştır. Hastanın EKG’sinde inferolateal derivasyonlarda ST elevasyonu elevasyonu; transtorasik ekokardiyografi’de ejeksiyon fraksiyonu (EF) %60, kapak ve duvar hareketleri normal, asendan aorta çapı 40 mm olarak ölçülmüş olup, lümen içerisinde diseksiyon ile uyumlu şüpheli flep görünümü ve Toraks BT anjiyografi’de RCA ostiumu kapatan flep gözlenmiştir. Hasta acil olarak ameliyata alınmış koroner ostium diseksiyonu saptandı. Diseke ostium kapatılarak, hastaya koroner baypas greftleme yapıldıktan sonra yoğun bakım ve serviste takip edildi. Takiplerinde sorun tespit edilmeyen hasta medikal tedavi önerilerek taburculuğu yapıldı.
The development of Ascending Aortic Dissection during diagnostic carotid imaging is a rare but life-threatening clinical scenario reported in the literature. In this study, a 69-year-old male patient underwent diagnostic imaging after experiencing a trans-ischemic attack. Carotid angiography revealed vascular abnormalities causing approximately 80% stenosis in the right ICA, leading to carotid stenting. Prior to the procedure, the patient described sudden, stabbing chest pain, prompting evaluation with electrocardiography, transthoracic echocardiography, and thoracic CT angiography. The patient's ECG showed ST elevation in the inferolateal derivations; transthoracic echocardiography revealed an ejection fraction (EF) of 60%, normal valve and wall motion, and an ascending aortic diameter of 40 mm and with a suspicious flap visible within the lumen consistent with dissection, and thoracic CT angiography showed a flap covering the RCA ostium. The patient was urgently taken to surgery. The patient underwent emergency surgery and a coronary ostium dissection was detected. After closing the dissected ostium and performing coronary bypass grafting, the patient was monitored in the intensive care unit and on the unit. No complications were detected during follow-up, and the patient was discharged with recommendations for medical treatment.
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