Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh; and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh; and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2019 Feb;107(2):e97-e99. doi: 10.1016/j.athoracsur.2018.06.047. Epub 2018 Aug 3.
A 68-year-old man presented with complaints of right-sided neck and chest pain with systolic blood pressure greater than 200 mm Hg but denied any recent blunt trauma or whiplash events. A computed tomography angiography demonstrated an acute dissection involving the origin of the right brachiocephalic artery that extended into the right common carotid and right subclavian arteries. The patient was neurologically intact and computed tomography angiography of the brain demonstrated a stable arachnoid cyst and a brain perfusion scan demonstrated homogenous perfusion. In the absence of strong indications for arch replacement, the patient was treated with warfarin and clopidogrel to prevent further thrombotic potentiation.
一位 68 岁男性因右侧颈部和胸部疼痛就诊，其收缩压高于 200mmHg，但否认有近期钝性创伤或挥鞭样损伤事件。计算机断层血管造影显示急性夹层累及右头臂动脉起始处，延伸至右颈总动脉和右锁骨下动脉。患者神经功能完整，脑计算机断层血管造影显示蛛网膜囊肿稳定，脑灌注扫描显示均匀灌注。鉴于没有强烈指征需要更换弓部血管，患者接受华法林和氯吡格雷治疗以预防进一步的血栓形成。
