Left common carotid artery ostium iatrogenic dissection: A case report and systematic review of the literature.

Background: Common carotid artery dissections (CCADs) are rare but potentially life-threatening, often leading to ischemic events. Iatrogenic CCADs have been reported, but this is the first case of an ostium-located CCAD occurring during cerebral angiography. A systematic review was conducted to identify similar cases. Methods: This case report followed the CAse REport (CARE) checklist, and the systematic review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A literature search was performed across PubMed, Embase, and Cochrane Library to identify case reports or series on iatrogenic CCADs. Results: An 81-year-old female undergoing follow-up cerebral angiography postaneurysm clipping developed an 80% left common carotid artery ostium stenosis due to a Simmons 2 catheter. She remained asymptomatic and was treated with dual antiplatelet therapy (aspirin and clopidogrel). The systematic review included eight studies (13 patients, mean age 58.2 years), with diverse iatrogenic causes, including catheter misplacement (n = 2), puncture accident (n = 1), endarterectomy (n = 1), carotid stenting (n = 1), tumor resection (n = 1), radiotherapy (n = 1), and cerebral angiography (without ostium involvement) (n = 1). Four of seven symptomatic patients had ischemic events, whereas others had neck pain, sedation, or were asymptomatic. Treatment varied, with only one patient experiencing persistent deficit (Horner syndrome). Conclusion: This is the first reported case of an ostium-located CCAD during routine angiography. The systematic review highlights the diverse etiologies and clinical courses of iatrogenic CCADs, underscoring the need for individualized management to optimize outcomes and reduce complications.