Nonoperative Management of Brachiocephalic Artery Dissection.

A 68-year-old male presented with complaints of right-sided neck and chest pain with systolic blood pressures >200mmHg but denied any recent blunt trauma or whiplash events. A computer tomography angiography (CTA) 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 CTA 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.