This study states that The first-line therapy for a carotid artery dissection is antiplatelet or anticoagulation or a combination of the two, with up to 90% of patients having full recovery. Surgical intervention is warranted in few cases. We present a case of a symptomatic carotid dissection that required open surgical resection of redundant internal carotid artery, septectomy of dissection flap, and reimplantation of the internal carotid artery to the common carotid artery. This is a video presentation of a 61-year-old man with known chronic type B aortic dissection extending into the bilateral common carotids and left internal carotid artery who had previous aortoiliac bypass graft for aortic aneurysmal degeneration secondary to dissection. The patient was maintained on best medical therapy with aspirin and warfarin. Since the previous clinic visit, the patient had new complaints of stroke symptoms including expressive aphasia, right facial weakness, and right arm weakness. The patient also had new bilateral parotid masses, left > right. Magnetic resonance imaging/angiography demonstrated two previous strokes in the left hemispheric distribution. The patient was evaluated by a neurologist, who determined, given the territory of the stroke, that it was likely attributed to the carotid dissection and definitive treatment was indicated. Carotid angiography was performed, demonstrating dissection of the left common carotid extending into the internal carotid, aneurysmal degeneration, and a highly tortuous, redundant left internal carotid artery with a 180-degree hairpin turn.


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