Endovascular Treatment of Common Carotid Artery Dissection Via the Superficial Temporal Artery

Abstract

To describe the endovascular treatment of an iatrogenic common carotid artery (CCA) dissection using the superficial temporal artery (STA) as the principal access. An 83-year-old man with a post-carotid endarterectomy left CCA dissection was admitted for a transient ischemic attack involving the left cerebral hemisphere that occurred despite proper anticoagulation. After excluding redo surgery and transfemoral stenting (owing to a partially compromised aortobifemoral bypass graft), stenting of the left CCA dissection was planned using a right transbrachial approach, with the left STA as an additional access. However, intraoperative angiography showed an acute angle between the innominate artery and left CCA, so the STA was used as the primary access route owing to its straight course and 4-mm diameter. The 9-x40-mm self-expanding stent was inserted via a 5-F sheath in the STA and deployed directly at the CCA dissection. The procedure was successful, and all vessels involved were patent at 6-month follow-up. In selected cases, the superficial temporal artery may represent a valid alternative approach for the endovascular treatment of short CCA dissections.