Interventional management for secondary intracranial extension of spontaneous cervical arterial dissection

Extracranial internal carotid artery occlusive dissection – multimodality presentation in a case series

Abstract. Background: Carotid dissection is a rare disease, mainly affecting young and middle-aged patients potentially ending up in stroke. Multimodality imaging plays an essential role, both in terms of prompt and accurate diagnosis and follow-up of this entity. Patients and methods: We herein present a case series of patients with internal carotid artery dissection and compare the various imaging findings of ultrasonography, multidetector computed tomography angiography and magnetic resonance angiography, with a purpose to illustrate the value of multimodality imaging in the diagnosis of carotid dissection. Results: Ultrasound represents the first-line imaging modality for the evaluation of a suspected carotid pathology. Digital subtraction angiography is considered the gold standard method for evaluation of carotid luminal abnormalities and is currently reserved for those patients selected for endovascular surgery. Nevertheless, the widespread availability of modern cross-sectional techniques such as multi-detector computed tomography angiography and magnetic resonance angiography has made angiography marginalised. Computed tomography and magnetic resonance angiography offered accurate delineation of vascular lumen and providing valuable information for the vascular wall composition. Conclusions: Careful interpretation of imaging findings on various imaging modalities can lead to early and accurate diagnosis of carotid dissection.

A systematic review of endovascular management of internal carotid artery dissections

BACKGROUND

We conducted a review of the safety and outcomes of endovascular intervention in patients with internal carotid artery dissection (ICAD).

SUMMARY

A literature review was performed. PubMed and Medline databases were searched from inception to September 2012 with the key words 'carotid artery' (title), 'dissection' (title) and 'endovascular' (title/abstract). All studies were included which reported outcomes of endovascular intervention in ICAD and provided information about technical and clinical results. After screening, we included 23 articles. In total, 201 patients (128 male and 73 female) were included in the eligible studies. The mean age was 46.7 years (range 13-83 years). Of the 201 patients, the causes of the carotid dissections were traumatic in 69 (34.3%), spontaneous in 115 (57.2%) and iatrogenic in 17 (8.5%). The technical success rate was 99.1%. The overall rate of major cardiovascular events in the perioperative period was 4%. No procedure-related deaths occurred. Imaging follow-up data (mean follow-up time 16.5 months) demonstrated that only 3.3% of patients had intimal hyperplasia or in-stent restenosis or occlusion of a treated vessel. Clinical follow-up data (mean follow-up period 20.9 months) showed that only 2.1% of patients had a recurrent transient ischemic attack in the territory of the treated vessel.

KEY MESSAGES

Endovascular intervention with stenting or stent-graft-supported angioplasty in selected patients with ICAD is promising. However, further evaluation is warranted to provide more evidence to support the feasibility of endovascular procedures in treating ICAD.