A Staged Therapy for Internal Carotid Artery Dissection Caused by Vascular Eagle Syndrome

Abstract

Eagle syndrome with stroke onset is a rare condition. Carotid stenting of dissected arteries and/or surgical resection of the elongated styloid process are frequently performed; however, there are no definitive criteria for selecting these treatments. A 46-year-old man presented with left hemiplegia. Acute infarction in the right frontal and parietal lobes and bilateral internal carotid artery (ICA) dissection due to the elongated styloid process were diagnosed via magnetic resonance imaging and computed tomography angiography. He was treated with stenting of the left ICA dissection, with observation of the right ICA dissection. However, the right ICA dissection deteriorated 4 days after the initial event, and additional stenting was performed. He underwent bilateral prophylactic styloidectomy with an extraoral approach 8 months after symptom onset. At >3 years after the styloidectomy, he has not experienced recurrence of the infarction. Stenting in the acute phase prevented the recurrence of stroke, and styloid process resection in the chronic phase cured vascular Eagle syndrome. This staged therapy could be beneficial in the treatment of vascular Eagle syndrome.