Arterial Flows in Carotid Artery Dissection

2007 ◽  
Author(s):  
Liang-Der Jou ◽  
Deok Hee Lee ◽  
Michel E. Mawad
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Dissecting Aneurysm ◽  
Carotid Artery Dissection ◽  
Arterial Stenosis ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Middle Aged ◽  
Interventional Management

Dissection at the carotid artery is not infrequent, and it may lead to arterial stenosis, dissecting-aneurysm, ischemia stoke, or subarachnoid hemorrhage [2]. The exact cause of carotid artery dissection remains unknown, but it occurs often among young and middle-aged individuals who are otherwise healthy [3]. Extra-cranial carotid dissection is often managed conservatively by anti-thrombotic therapy, while the intracranial carotid dissection often requires interventional management.

Traumatic Carotid Artery Dissection and Pseudoaneurysm Treated with Endovascular Coils and Stent

1997 ◽  
Vol 4 (4) ◽  
pp. 339-343 ◽  
Author(s):  
John H. Matsuura ◽  
David Rosenthal ◽  
Hilde Jerius ◽  
Michael D. Clark ◽  
David S. Owens
Keyword(s):  
Carotid Artery ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Pseudoaneurysm Formation ◽  
Vehicle Accident ◽  
Detachable Coils ◽  
Base Of The Skull

Purpose: To report a case of post-traumatic internal carotid artery dissection and pseudoaneurysm formation at the C-1 level successfully treated by a percutaneous endovascular technique. Methods and Results: A 20-year-old female presented 72 hours after a motor vehicle accident with incomplete occulosympathetic paresis (Horner's syndrome), carotidynia, and left-sided weakness. Arteriography confirmed the diagnosis of carotid dissection and an associated 1.5-cm × 2.5-cm pseudoaneurysm at the C-1 level. Neuroradiologists embolized the pseudoaneurysm with Guglielmi detachable coils and controlled the dissection with placement of a Wallstent. Conclusions: This report illustrates successful percutaneous endovascular treatment of a carotid dissection and pseudoaneurysm near the base of the skull.

scholarly journals Intentional subintimal carotid stenting of internal carotid dissection in a patient with acute ischaemic stroke

2016 ◽  
Vol 23 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Nicola Limbucci ◽  
Sergio Nappini ◽  
Andrea Rosi ◽  
Leonardo Renieri ◽  
Arturo Consoli ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Clinical Recovery ◽  
Intracranial Embolism

Carotid artery dissection is a common cause of juvenile stroke. Endovascular treatment of acute stroke due to carotid dissection can be challenging, and endoluminal crossing of the dissection is sometimes impossible. We describe a case of intentional subintimal recanalisation of a cervical carotid dissection followed by intracranial thrombectomy and stenting. We report the case of a young woman with severe acute ischaemic stroke due to carotid artery dissection and intracranial embolism. After failure of endoluminal crossing of the dissected segment, intentional subintimal crossing with re-entry distally to the dissection was achieved and a stent was deployed. Then, middle cerebral artery thrombectomy was performed achieving good recanalisation. Acute thrombus formed in the bulged segment of the carotid stent and was managed with additional stent placement. The patient had a good clinical recovery. In selected cases, after failure of conventional techniques, subintimal recanalisation of carotid dissections may be performed.

Carotid Artery Dissection-Related Intracranial Aneurysm Development

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E511-E515 ◽  
Author(s):  
Giuseppe Esposito ◽  
Giovanni Sabatino ◽  
Giorgio Lofrese ◽  
Alessio Albanese
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Scan ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Neurological Conditions

Abstract BACKGROUND AND IMPORTANCE: We analyzed the physiopathology of the association between cervical artery dissections (CADs), intracranial aneurysms (IAs), and aneurysmal subarachnoid hemorrhage. CLINICAL PRESENTATION: A 43-year-old woman presented with diffuse subarachnoid hemorrhage (Fisher 3; Hunt-Hess 1). computed tomography angiography revealed a cervical internal carotid artery dissection and 2 IAs: right paraclinoid and right posterior communicating artery. The patient underwent surgical clipping of the 2 aneurysms. CAD was managed conservatively. Postoperative course was initially uneventful. After 24 hours, digital subtraction angiography (DSA) documented the exclusion of the aneurysms and an improvement of the CAD. After 3 days, the patient's neurological condition suddenly worsened; CT scan documented a subarachnoid rebleeding (Hunt-Hess 4) and DSA revealed the recurrence of CAD and a new right internal carotid artery aneurysm. The patient underwent clipping of the new aneurysm and decompressive craniectomy because of severe brain swelling. Postoperative neurological conditions remained poor. DSA showed the exclusion of the aneurysms and improvement of CAD. Three days later, CT scan performed after a sudden raise in intracranial pressure documented a wide intracerebral hematoma. Computed tomography angiography did not show new vascular malformations. Surgical removal of the hematoma was performed, but poor neurological conditions persisted. CONCLUSION: CAD-related hemodynamic changes may play a role in the development of IAs. The presence of IAs must be screened carefully in case of CAD, because the dynamic behavior of CAD definitively increases the risk of IA formation, enlargement, and rupture.

Carotid Dissection

2015 ◽  
Author(s):  
Efthymios D. Avgerinos ◽  
Peter Schneider ◽  
Rabih A. Chaer
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Procedures ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Artery Wall ◽  
Ultrasound Findings ◽  
History Of

Carotid artery dissection refers to an intimal tear and eventually hematoma of the carotid artery wall. Although medical therapy is the mainstay of treatment, surgical or endovascular procedures may be indicated to address fluctuating neurologic deficit or expanding pseudoaneurysm. This review surveys the pathophysiology and natural history of carotid dissection and summarizes the results of recent trials and evolving therapeutic options. A table highlights factors predisposing to or potentially associated with carotid dissection. Figures include an illustration of the pathophysiology of internal carotid artery dissection (ICAD); angiograms revealing right internal carotid artery tapering stenosis to occlusion, right internal carotid artery carotid dissection, and distal left ICAD; ultrasound findings of ICAD; and an algorithm for the diagnosis and management of carotid dissection. This review contains 6 figures, 1 table, and 83 references.

scholarly journals Subarachnoid hemorrhage and internal carotid artery dissection and occlusion following self-enucleation

2020 ◽  
Vol 15 (4) ◽  
pp. 1050
Author(s):  
Siviero Agazzi ◽  
Hadi Joud ◽  
MohammadHassan A. Noureldine ◽  
Ivo Peto ◽  
JayI Kumar ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection

Abstract T P24: Neurointervention for Acute Ischemic Stroke Caused by Carotid Dissection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Diogo C Haussen ◽  
Andrey Lima ◽  
Mikayel Gregoryan ◽  
Jonathan Grossberg ◽  
Leah Craft ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Hemorrhagic Transformation ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Stroke Severity ◽  
Carotid Dissection ◽  
Increased Risk

Introduction: Data related to the treatment of patients with acute ischemic stroke caused by carotid artery dissection is scarce. Methods: We retrospectively reviewed our interventional stroke database Sep 2010 - Jan 2014 to investigate the clinical and radiological characteristics of patients presenting with tandem cervical and intracranial occlusions due to cervical carotid dissection. Results: Out of 504 consecutive patients treated with endovascular therapy for acute ischemic stroke during the study period, 12 (2.5%) patients were observed to have cervical carotid artery dissection as the underlying etiology. Mean age was 56±13 years, 75% were male, 50% received IV t-PA, mean NIHSS was 20±5, 75% had CT ASPECTS≥7, and mean time from last known normal to groin puncture was 6±3 hours. There were 4 MCA M1, 1 MCA M2 and 7 ICA-T occlusions. Extracranial carotid stent was used in 58% and angioplasty in 8% of cases. In 33% of the cases, the carotid dissection was not stented due to the fear of hemorrhagic transformation in cases of IV thrombolysis (presumably increased risk if dual antithrombotics used). IA tPA was used in 41% of cases, while Merci in 16%, Penumbra in 58%, and stentretrivers in 50%. Intracranial TICI 2b-3 reperfusion was achieved in 91% of patients, with PH2 hemorrhage in 8% and mRS at 90 days in 45% of cases. Conclusions: Carotid dissections with associated intracranial occlusions are often refractory to IV tPA and present with a high stroke severity. These lesions are amenable to endovascular therapy resulting in high rates of reperfusion with an acceptable safety profile.

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