Dissecção Bilateral Extracraniana da Artéria Carótida Interna: Manejo Intervencionista – Relato de Caso
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Resumo
A dissecção traumática da artéria carótida interna (DACI), especialmente em casos bilaterais, é uma condição rara, mas potencialmente fatal, que apresenta desafios diagnósticos e terapêuticos. O segmento cervical da artéria carótida interna (ACI) é particularmente vulnerável a lesões após traumas contusos, muitas vezes levando a sequelas neurológicas significativas. Apesar das diretrizes estabelecidas que recomendam o manejo conservador como abordagem inicial, o momento ideal e os critérios para intervenção endovascular continuam sendo áreas de investigação contínua. Relatamos o caso de uma paciente de 38 anos que apresentou DACI extracraniana bilateral após um acidente de automóvel. Inicialmente, a paciente apresentou hemiparesia direita e afasia, e a imagem confirmou DACI extracraniana esquerda sem estenose crítica ou formação de pseudoaneurisma. O manejo conservador com terapia antiplaquetária dupla foi orientado por achados de imagem e avaliação de risco, levando a uma melhora sintomática temporária. No entanto, a paciente retornou no oitavo dia com hemiplegia esquerda e perda de consciência, levando a uma nova imagem que revelou dissecção bilateral e infarto da artéria cerebral anterior direita. Dada a falha da terapia médica, foi realizado stent endovascular, alcançando revascularização bem-sucedida e melhora dos sintomas. O manejo da DACI traumática, especialmente em casos bilaterais, exige avaliação cuidadosa de risco e intervenção oportuna. Nosso caso destaca a importância da imagem na orientação do processo de tomada de decisão e no equilíbrio entre estratégias de manejo conservador e invasivo. O stent endovascular, embora eficaz, deve ser reservado para casos com sintomas progressivos ou quando o manejo médico falha. Este relato contribui para a literatura limitada sobre DACI traumática bilateral e enfatiza a necessidade de mais pesquisas para estabelecer diretrizes baseadas em evidências para o manejo de tais casos. Estudos futuros devem comparar os resultados de intervenções conservadoras, cirúrgicas e endovasculares para otimizar o cuidado ao paciente e melhorar os prognósticos.
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