Bilateral Carotid Artery Dissection Research Articles

Bilateral spontaneous carotid artery dissection concomitant with early-stage COVID‑19.

Bilateral spontaneous carotid artery dissection concomitant with early-stage COVID‑19.

Bilateral carotid artery dissection associated with Eagle syndrome in a drug-addicted young adult with stroke: a case report

Bilateral carotid artery dissection associated with Eagle syndrome in a drug-addicted young adult with stroke: a case report

Bilateral Common Carotid Artery Dissection Presenting as Delayed Cerebral Ischemia (2624)

Bilateral Common Carotid Artery Dissection Presenting as Delayed Cerebral Ischemia (2624)

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

Acute cerebrovascular disease, particularly ischemic stroke, has emerged as a serious complication of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of the Coronavirus disease‐2019 (COVID-19).Accumulating data on patients with COVID-19-associated stroke have shed light on specificities concerning clinical presentation, neuroimaging findings, and outcome.Such specificities include a propensity towards large vessel occlusion, multi-territory stroke, and involvement of otherwise uncommonly affected vessels. Conversely, small-vessel brain disease, cerebral venous thrombosis, and intracerebral hemorrhage appear to be less frequent. Atypical neurovascular presentations were also described, ranging from bilateral carotid artery dissection to posterior reversible encephalopathy syndrome (PRES), and vasculitis. Cases presenting with encephalopathy or encephalitis with seizures heralding stroke were particularly challenging. The pathogenesis and optimal management of ischemic stroke associated with COVID-19 still remain uncertain, but emerging evidence suggest that cytokine storm-triggered coagulopathy and endotheliopathy represent possible targetable mechanisms. Some specific management issues in this population include the difficulty in identifying clinical signs of stroke in critically ill patients in the intensive care unit, as well as the need for a protected pathway for brain imaging, intravenous thrombolysis, and mechanical thrombectomy, keeping in mind that “time is brain” also for COVID-19 patients. In this review, we discuss the novel developments and challenges for the diagnosis and treatment of stroke in patients with COVID-19, and delineate the principles for a rational approach toward precision medicine in this emerging field.

Bilateral carotid artery dissection due to Eagle syndrome in a patient with vascular Ehlers-Danlos syndrome: a case report

BackgroundPatients with vascular Ehlers-Danlos syndrome (EDS) occasionally suffer from arterial dissection. Eagle syndrome, which is caused by an elongated styloid process and also causes arterial dissection, is difficult to diagnose and could sometimes be overlooked. Little is known of the coexistence of these two diseases, and treatment strategy is not established. Here, we present a case of bilateral internal carotid artery (ICA) dissection due to Eagle syndrome in a patient with vascular EDS.Case presentationA 30-year-old man was admitted to our hospital because of sudden onset of mild sensory disturbance in his left limbs. He had a history of Ehlers-Danlos syndrome (EDS) and also had left cervical internal carotid artery (ICA) dissection 3 years before. Diffusion-weighted imaging showed acute cerebral infarcts in the right hemisphere. Cervical computed tomography angiography (CTA) revealed the right ICA narrowing at the cervical portion in addition to the previous left cervical ICA dissection. Cervical magnetic resonance imaging (MRI) revealed double-lumen and intramural hematoma at the narrowing portion of the right cervical ICA, which indicates arterial dissection. CT also revealed bilateral elongated styloid processes which are close to each side of cervical ICA. We diagnosed him as bilateral ICA dissection due to bilateral Eagle syndrome. Considering vascular complications due to vascular EDS, we performed closer follow-up with transoral carotid ultrasonography (TOCU). In 4 months, his right ICA dissection gradually improved without stroke recurrence or deterioration of dissection.ConclusionsSince patients with vascular EDS easily develop arterial dissection, Eagle syndrome may be overlooked. Clinicians should consider Eagle syndrome in the case of vascular EDS with extracranial ICA dissection and close follow-up should be prioritized in cases of Eagle syndrome with vascular EDS.

Endovascular Repair of Bilateral Carotid Dissection in a Near Hanging Victim

IntroductionThere is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management.ReportA 50 year old male patient was admitted after attempted suicide through hanging, having been swiftly rescued by a bystander. On admission, six hours after the event there was no neurological deficit. There was evidence of soft tissue damage related to the rope position, subcutaneous emphysema, and neck swelling. The CT angiogram showed dissection of both common carotid arteries with significant luminal narrowing as well as fracture of the thyroid cartilage; brain injury was excluded. Heparin infusion was started and an endovascular repair with bilateral covered stent placement, requiring coverage of the external carotid artery on the left side, was performed. The vascular procedure was uneventful. The patient was discharged 36 days after the event, on dual antiplatelet drugs and under regular psychiatric and speech therapy care, and is currently alive and well 22 months after surgery with no neurological damage.DiscussionThe choice of treatment was not straightforward as there are no guidelines or consensus around its management. In this case, however, an endovascular repair seemed suitable and the result was optimal, with no neurological damage and a good result after 22 months.

Intravascular Ultrasound for Intracranial and Extracranial Carotid Artery Stent Placement

Intravascular ultrasound (IVUS) can provide valuable information regarding endoluminal morphology. We present the first description of IVUS-guided intracranial and extracranial carotid artery stent placement for arterial dissection. A 41-year-old female with a sudden-onset headache and blurred vision underwent a computed tomography (CT) angiogram imaging that revealed bilateral carotid artery dissections (BCAD) and a left vertebral artery dissection (VAD). Endovascular treatment (EVT) of a long segment right carotid artery dissection (CAD) was performed employing two Carotid WALLSTENT™ Monorails™ (8 x 36 mm, 10 x 31 mm) (Boston Scientific, Marlborough, MA). With the help of the IVUS, the distal stent was placed up to the petrous carotid artery, followed by the placement of the second stent in the immediate proximal location with some overlap that extended down to the carotid artery bulb. Intraoperative angiography and post-stenting IVUS revealed excellent stent placement with good resolution of the dissection and good luminal patency with pseudolumen obliteration. Stent use for intracranial circulation dissections will continue to be a favorable option given the decreased morbidity of endovascular therapy in this location. As endovascular surgeons become more facile with the use of IVUS, using it as a guide for stent placement and post-stenting confirmation will help them to ensure proper positioning and improved patency rates.

Traumatic bilateral carotid and vertebral artery dissection

Traumatic bilateral carotid and vertebral artery dissection

Dissection artérielle cervicale néonatale secondaire à un traumatisme obstétrical

Cervical artery dissection is rare in the neonatal period and is most often caused by birth injury during dystocic labor. The severity of this pathology is due to the possibility of serious neurological complications. We report a case of a male newborn who was born vaginally after shoulder dystocia. The extraction was difficult, resulting in a fracture of the right humerus. On the second day of life, the child presented generalized clonic convulsions. Computed tomography of the brain showed an ischemic stroke in the territory of the right middle cerebral artery, the territory of the right posterior cerebral artery, and the right lenticulostriate and capsular regions. Doppler ultrasonography and magnetic resonance angiography showed bilateral carotid artery thrombosis and dissection at the left common carotid artery and its two branches and the right vertebral artery. We discuss the mechanisms of this pathology and we emphasize preventive measures.

Spontaneous bilateral carotid artery dissection in a patient with bovine aortic arch

Carotid artery dissections are commonly associated with trauma or various connective tissue disorders. Dissection of the cerebrovascular arteries can result in ischemic stroke and is a frequent stroke etiology in younger patients. Anatomical variants of aortic arch branching, such as the 'bovine' aortic arch, are assumed to have little or no physiological consequence. To the best of our knowledge, we present for the first time a case of spontaneous dissection of the common origin of the innominate and left common carotid artery in a bovine aortic arch, resulting in bilateral dissection of the carotid arteries.

Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection

The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported. Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Follow-up imaging revealed no vessel irregularities, the left internal carotid artery was still occluded. This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.

Bilateral Carotid and Vertebral Artery Dissection Following Cesarean Section (PD7.007)

Bilateral Carotid and Vertebral Artery Dissection Following Cesarean Section (PD7.007)

Endovascular Treatment of Bilateral Carotid Artery Dissections Progressing to Pseudoaneurysms After Blunt Carotid Injury: A Case Report and Review of the Literature

Endovascular Treatment of Bilateral Carotid Artery Dissections Progressing to Pseudoaneurysms After Blunt Carotid Injury: A Case Report and Review of the Literature

Spontaneous bilateral carotid artery dissection following cervical manipulation

We report an autopsy case of a bilateral carotid artery dissection, following cervical manipulation by a chiropractor. To establish the etiology of a cervical artery dissection is important in view of possible legal implications and to exclude hereditary disorders, since cervical artery dissection has been linked to several arteriopathies. The underlying arteriopathy in the presented case was an idiopathic cystic medial degeneration. This report emphasizes the role of the pathologist in defining the underlying arteriopathy in carotid artery dissection.

Multiple strokes and bilateral carotid dissections: A fulminant case of newly diagnosed Ehlers–Danlos Syndrome Type IV

Ehlers–Danlos Syndrome is a rare group of inheritable disorders resulting in abnormal collagen production, leading to skin fragility, joint hypermobility and easy bruising. Six major subtypes have been identified, of which Type IV most often leads to neurovascular complications, may lead to inner organ rupture and overall has the worst prognosis. Early recognition followed by genetic testing is key, since this diagnosis will guide decision making in the management of complications, influence the choice of antiplatelet medications versus anticoagulants and allow for potentially affected family members to be identified, undergo genetic testing and reproductive counseling.We here report the case of a 50year old woman with a fulminant presentation of Ehlers Danlos Syndrome Type IV, including bilateral carotid and vertebral artery dissection, multiple strokes and liver rupture. Of note, this patient did not have a known history or obvious clinical features of connective tissue disease. Genetic testing confirmed the diagnosis. Review of her family history revealed multiple family members with a history of aortic dissection or aneurysm rupture.This case illustrates that Ehlers Danlos Syndrome Type IV is an important differential diagnosis even in adult patients without a known history of connective tissue disease and no prior complications.

Bilateral Cervical-Artery Dissection Associated with Leri-Weill Dyschondrosteosis. A Case Report and Literature Review (P01.022)

Objective: To report the first case of spontaneous cervical-artery dissection (sCAD) associated with Leri-Weill dyschondrosteosis (LWD) and a comprehensive review of the literature. Background CAD is a major cause of cerebral ischemia in young adults. Skin biopsies from many patients with sCAD show mild connective tissue alterations. An underlying arteriopathy, which could be in part genetically determined, is believed to have a role in the development of sCAD. There are few case reports of sCAD in patients with inherited connective tissue disorders like Ehlers-Danlos syndrome, Marfan syndrome or Osteogenesis Imperfecta. LWD is an osteochondrodysplasia whith mesomelic short stature and Madelung deformity of the wrist. Expression of LWD is variable but the clinical features are generally more severe in females. In around 70% of cases, LWD is caused by haploinsufficiency of the short stature homeobox (SHOX) gene and remains unknown in the remaining 30%. Design/Methods: Case report followed by a literature review. Results: A 36-years-old woman was admitted in July 2009 for sudden-onset right hemiplegia and Wernicke aphasia. Her NIHSS was 9. Her past medical history consisted in LWD and hypothyroidism treated with levothyroxine sodium. She had had no injuries during the previous days or weeks. The diffusion-weighted MRI showed a left carotid infarct. Laboratory test results and cardiac explorations were normal. Magnetic resonance angiography combined with T1-weighted with the fat-saturation technique confirmed bilateral carotid artery dissection. Anticoagulation was conducted for 6 months then was relayed by antiplatelet. When last seen in April, 2011, the patient had only minor aphasia and the MRI was back to normal. Conclusions: Even though this association is rare, screening patients with sCAD for clinical signs that are suggestive of connective tissue seems important. In such cases, a longer and closer follow-up is recommended because of the heightened risk of recurrence. Disclosure: Dr. Bonnet has nothing to disclose. Dr. Cogez has nothing to disclose. Dr. Bataille has nothing to disclose. Dr. Defer has received personal compensation for activities with BiogenIdec, Novartis, Teva Pharmaceutical Industries Ltd, Merck Serono, and Guerbet. Dr. Viader has nothing to disclose.

Pearls & Oy-sters: Unusual manifestations of bilateral carotid artery dissection

A 44-year-old man in good general health presented with a 1-week history of deep-seated, moderate right eye pain without exacerbation on eye movement. Ophthalmologic examination showed visual acuity of 20/20 in both eyes, equal pupils with normal pupillary reflexes, mild right upper lid ptosis known to the patient for more than 5 years, and normal fundus examination in both eyes. Neurologic examination was normal. There was no history of head or neck trauma in the past weeks. Cocaine drop test for Horner syndrome was negative. Fluorescein and indocyanine green angiography were normal without delayed arterial filling. Cranial MRI with fat-saturated sequences and magnetic resonance angiography (MRA) revealed bilateral acute internal carotid artery (ICA) dissections without fibromuscular dysplasia (figure 1, A–C). Aspirin 100 mg a day was …

Dysautonomia From Bilateral Carotid Artery Dissection

The mechanisms of dysautonomia from carotid artery dissection were discussed recently in Circulation . A case was presented of a 49-year-old woman with a history of hypertension and vasovagal syncope who developed abrupt slurred speech and left hemiplegia.1 She had a right internal carotid artery dissection and right cerebral hemispheric infarction involving the insular cortex. During her hospitalization, the patient had episodes of severe bradycardia that Dulay et al1 attributed to “mechanical pressure to an already sensitive carotid sinus from thrombus secondary to a dissection of the internal carotid.” Sarikaya et al2 argued that disrupted descending autonomic pathways from the infarcted insular cortex were responsible. Right-sided insular lesions are known to cause bradyarrhythmias.3 We present a case of bilateral carotid artery dissection in which dysautonomia occurred in the absence of cortical damage. A 47-year-old right-handed woman with rheumatoid arthritis experienced symptoms of an apparent upper respiratory infection with a persistent cough after the syndrome resolved. After …

Bilateral common carotid artery dissection following aortic dissection type A repair

Bilateral common carotid artery dissection following aortic dissection type A repair

Unusual Manifestations of Bilateral Carotid Artery Dissection: Dysphagia and Hoarseness

Dissection of the carotid artery can occur intracranially or extracranially, although dissections tend to affect extracranial segments of the arteries much more commonly than intracranial segments. Carotid artery dissection (CAD) is most common in middle-aged women. Although not completely known, the main risk factors related to carotid artery dissection are genetic and environmental factors, traumatic events, cervical manipulation, migraine, recent infections, hyperhomocysteinemia, and hereditary connective tissue disorders. Although some cases of bilateral internal CAD have been reported, spontaneous bilateral dissections are rare. Prolonged hoarseness is usually due to using the voice either too much, too loudly, or improperly over an extended period of time. Disorders leading to dysphagia may affect the oral, pharyngeal, or esophageal phases of swallowing. In this study we report on a patient with bilateral CAD who presented to our clinic with dysphagia and hoarseness.