Carotid Artery Dissection Research Articles

Lower Cranial Neuropathies as Presenting Symptom of Distal Extracranial Internal Carotid Artery Dissection Leading to Delay in Diagnosis and Treatment (P7-5.030)

Lower Cranial Neuropathies as Presenting Symptom of Distal Extracranial Internal Carotid Artery Dissection Leading to Delay in Diagnosis and Treatment (P7-5.030)

Ischemic stroke caused by bilateral internal carotid artery dissection due to elongated styloid processes: A case report

Ischemic stroke caused by bilateral internal carotid artery dissection due to elongated styloid processes: A case report

Bailout Distal Internal Carotid Artery Stenting After Carotid Endarterectomy: Indications, Technique, and Outcomes

Distal internal carotid artery (ICA) stenting may be employed as a bailout maneuver when an inadequate endpoint or clamp injury is encountered at the time of carotid endarterectomy (CEA) in a surgically inaccessible region of the distal ICA. We sought to characterize the indications, technique, and outcomes for this infrequently encountered clinical scenario. We performed a retrospective review of all patients who underwent distal ICA stenting at the time of CEA at our institution between September, 2008 and July, 2022. Procedural details and postoperative follow up were reviewed for each patient. Six patients were identified during the study period. All were male with an age range from 63-82 years. Five underwent carotid revascularization for asymptomatic carotid artery stenosis, and one patient was treated for amaurosis fugax. Three patients were on dual anti-platelet therapy (DAPT) preoperatively, whereas two were on aspirin monotherapy, and one was on aspirin and low dose rivaroxaban. Five patients underwent CEA with patch angioplasty and one underwent eversion CEA. The indication for stenting was distal ICA dissection due to clamp or shunt injury in two patients and inadequate distal ICA endpoint in four patients. In all cases, access for stenting was obtained under direct visualization within the common carotid artery (CCA) and a standard carotid stent was deployed with its proximal aspect landing within the endarterectomized site. Embolic protection was typically achieved via proximal CCA and external carotid artery (ECA) clamping for flow arrest with aspiration of debris before restoration of antegrade flow. There was 100% technical success. Postoperatively, two patients were found to have cranial nerve injury, likely occurring due to the need for high ICA exposure. Median length of stay was 2 days (range 1-7 days) with no instances of perioperative stroke or myocardial infarction. All patients were discharged on DAPT with no further occurrence of stroke, carotid re-stenosis or re-intervention through a median follow up of 17 months. Distal ICA stenting is a useful adjunct in the setting of CEA complicated by inadequate endpoint or vessel dissection in a surgically inaccessible region of the ICA and can minimize the need for high-risk extensive distal dissection of the ICA in this situation.

[Thrombolysis treatment and multi- disciplinary management of central retinal artery occlusion in comparison with traditional ophthalmological treatment options].

<p>The management of central retinal artery occlusion (CRAO) has long been conservative therapy with limited efficacy carried out in ophthalmology departments together with etiolo&shy;gi&shy;cal investigations lacking a standardised protocol. However, CRAO is analogous to ischemic central nervous system stroke and is associated with increased stroke risk, thus, systemic thrombolysis treatment and multidisciplinary management can be beneficial. Since May 2022, at Semmelweis University CRAO patients diagnosed within 4.5 hours are given intravenous thrombolysis therapy and undergo etiologic workup based on current stroke protocols. Here we report our experience with the multidisciplinary, protocol-based management of CRAO in comparison with former non-protocol based ophthalmological conservative treatment.</p>. <p>We reviewed CRAO patients&rsquo; data treated conservatively and with paracentesis within 6 hours at the Department of Ophthalmology between 2013 and 2022 including changes in visual acuity, neurolo&shy;gical and cardiovascular findings compared to those in the thrombolysis project.&nbsp;</p>. <p>Of the 78 patients receiving non-protocol care, visual improvement was seen in 37% with natural course, 47% with conservative treatment and 47% with paracentesis. Four patients had significant carotid stenosis (2 underwent endarterectomy), 1 carotid dissection, 6 cardioembolism and 1 giant cell arteritis. Of the 4 patients within 4,5 hours, 3 gave their consent to the clinical trial and were treated with thrombolysis and underwent a full etiological assessment.&nbsp;<br>2 pa&shy;tients had improved visual acuity, 2 pa&shy;tients had significant carotid stenosis and underwent endarterectomy, 1 patient was started on anticoagulation for newly diagnosed atrial fibrillation.</p>. <p>CRAO patients presenting within 4,5 hours are rare and more patients are needed in our study to establish the efficacy of thrombolysis. However uniform protocollized evaluation helps identifying embolic sources thus, avoiding further and potentially more serious thromboembolic events.</p>.

Acute Ischaemic Stroke in a Young Adult in Sub-Saharan Africa: A Case Report of Post-strangulation Carotid Artery Dissection

Cerebrovascular accidents (CVA) remain one of the major causes of disabilities and mortality worldwide. In the young, carotid artery dissection (CAD) accounts for close to one-quarter of ischaemic strokes, occurring either spontaneously or due to a traumatic mechanism such as strangulation. We hereby, report a case of a young adult with large-vessel occlusion due to post-strangulation internal CAD. This case highlights the importance of raising awareness of the possibility of CAD in the presence of any focal neurologic deficit due to strangulation.

Internal carotid artery dissection associated with acute dengue virus infection: a case report

Cervical artery dissections (CAD) can occur spontaneously or as a direct result of significant trauma. Viral infections, such as SARS-CoV2, influenza, and Epstein Barr, are risk factors for spontaneous CAD. Dengue virus infections have dramatically increased in recent decades, and Brazil is one of the endemic areas. The dengue virus can cause headache and neurological complications such as encephalitis, myelitis, Guillain-Barré syndrome, and myositis. No report has yet been found in the literature of dissection of the internal carotid artery secondary to dengue infection. Our objective is to report the case of a patient with dissection of the internal carotid artery associated with acute dengue virus infection.

Acute Ischemic Stroke in a 41-year-old Female Secondary to Internal Carotid Artery Dissection: A Case Report

Spontaneous carotid artery dissection is an important cause of ischemic stroke and is most common in young and middle-aged adult patients. Dissection occurs after tearing of the intima layer of the artery causes the formation of a thrombus (intramural), and it leads to thrombosis or embolism. The thrombosis or embolism, in turn, interrupts arterial circulation and, subsequently, induces infarction in the territory of the affected artery. The case of an ischemic vascular event involving the left cerebral hemisphere secondary to a spontaneous dissection of the left internal carotid artery is presented here.

Importance of cerebral angiography in the evaluation of delayed carotid stent thrombosis: a case report

BackgroundWhile noninvasive imaging is typically used during the initial assessment of carotid artery disease, digital subtraction angiography remains the gold standard for evaluating carotid stent thrombosis and stenosis (Krawisz in Cardiol Clin 39:539–549, 2021). This case highlights the importance of digital subtraction angiography for assessing carotid artery stent patency in place of non-invasive imaging.Case presentationWe present a 61-year-old African American male patient with a history of right cervical internal carotid artery dissection that was treated with carotid artery stenting and endovascular thrombectomy, who developed recurrent right hemispheric infarcts related to delayed carotid stent thrombosis. Digital subtraction angiography found multiple filling defects consistent with extensive in-stent thrombosis not clearly observed with magnetic resonance angiography. Etiology was likely secondary to chronic antiplatelet noncompliance. Therefore, the patient was treated medically with a heparin drip, and dual antiplatelet therapy (dAPT) was restarted. At 1-month follow-up the patient did not report new motor or sensory deficits.ConclusionIn the setting of delayed carotid stent thrombosis secondary to antiplatelet noncompliance, digital subtraction angiography may play an essential diagnostic role for early identification and determination of the most appropriate treatment.

Abstract TP280: Monogenetic Stroke Syndrome Testing in Adults: A Single Center Experience

As access and coverage of genetic testing has increased, it is being used more commonly in adults with strokes. However, no clear guidelines exist for who should undergo genetic testing. Our retrospective review aims to provide guidance in this regard and show our experience. Genetic testing was ordered at our comprehensive stroke center between June 2022 and September 2023. Tests were ordered from GeneDx and genetic material was collected by buccal swab after consent was obtained. Most of the testing was done routinely in the outpatient setting, but was rarely performed inpatient when diagnosis would change acute management. Genetic testing was ordered for 41 patients. Tests ordered included whole exome sequencing, mitochondrial genome sequencing, Marfan syndrome and thoracic aortic aneurysm and dissection panel, Disorders of connective tissues panel and expedited whole genome sequencing. Indications for testing included evaluation of carotid and vertebral dissections, recurrent stroke, cryptogenic stroke, and leukoencephalopathy. The average age of tested patients was 47. Of these patients, 6 had not had a stroke and the testing was ordered to evaluate etiology of vertebral or carotid dissections. Of the 35 patients being evaluated for stroke etiology, 60% had at least one stroke or TIA prior to presentation. Of patients tested, 14 had evidence of dissection in the carotid arteries or vertebral arteries. At the time of analysis, 27 patients had results available, of which 15 had negative results. Positive results with pathogenic variant were seen in 4 patients. Pathologic variants detected included mutations in ABCC6, NOTCH3, MT-TL1, HBB, and MCCACHC genes. Variants of unknown significance were seen in 8 patients. These variants included mutations in MYLK, COL5A1, COL5A2, KRIT1, CCM2, XPR1, MT-CYB, MT-ND4, and MT-ATP6 genes. This study highlights that in the right clinical population, like young patients with recurrent stroke, genetic testing can be helpful to elucidate the etiology of cerebrovascular disease when standard stroke work up is inconclusive. With retrospective review, we aim to provide guidance on indications for genetic testing in adults with stroke and dissection.

Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy

The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome. We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT. During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results. ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.

Abstract 100: Impact of Dissection Location on Subsequent Stroke Risk: A Nationwide Analysis

Introduction: Cervical artery dissection (CAD) is a frequent cause of acute ischemic stroke (AIS) in young adults. We conducted a nationwide study to investigate potential predictors for subsequent AIS following CAD. Method: Adult patients diagnosed with non-traumatic CAD, and without any previous or concurrent stroke (2016-2020), were identified from the Nationwide Readmission Database using validated and standard ICD-10 CM codes. Significant demographic and clinical factors associated with 90-day AIS risk were identified through weighted survey univariate logistic regression followed by a multivariate Cox regression model. Result: Among 13,905 CAD patients (mean age 54.6±0.2, 54.8% female), 215 (1.5%) had subsequent AIS within 90 days of discharge with the median stroke occurrence on day 8. Patients with AIS were significantly older (58.3±1.3 vs. 54.5±0.2, P =0.026), and more commonly had vertebral artery dissection (51.6% vs. 41.0%, P =0.046), and coronary artery disease (24.7% vs. 15.6%, P =0.019). After including all these significant variables, the vertebral artery location of the dissection emerged as the sole significant predictor of subsequent AIS (adjusted HR 1.64, 95% CI 1.07-2.50, P =0.022). A Kaplan-Meier curve validated these findings, showing a higher AIS risk with vertebral versus carotid artery dissections (Figure). Notably, other risk factors such as hyperlipidemia and hypertension lacked significant association with AIS. Conclusion: Our study identifies vertebral artery dissection as a significant risk factor for 90-day AIS occurrence post CAD. This highlights the need for research into tailored management strategies for these patients to reduce stroke risk.

Abstract TP173: Differential Outcomes and Treatment in Vertebral versus Carotid Artery Dissections: A National Inpatient Sample Study

Introduction: Cervical artery dissection (CAD) involves the carotid (CCAD) or vertebral artery (VCAD). However, limited studies have compared their clinical features and outcomes. Our study utilized a comprehensive nationwide database to discern these differences. Method: We examined non-traumatic CAD-diagnosed patients from the U.S. National Inpatient Sample (2005-2019) using ICD-9 and ICD-10 codes. The evaluation included patient demographics, comorbidities, in-hospital complications, treatment, and costs. Differences between CCAD and VCAD were assessed using survey-weighted stepwise backward logistic regression, followed by propensity score matched adjusted regressions for outcomes. Result: From 2005 to 2019, we identified 157,086 CAD admissions, of which 79.9% (125,477) were spontaneous CADs, with CCAD outnumbering VCAD (67,671 vs. 57,806). Compared to VCAD, CCAD was significantly associated with older age (54 [44-66] vs. 49 [37-62]), Black race (12.6% vs. 8.7%), atrial fibrillation (6.1% vs. 3.7%), hypertension (58.0% vs. 53.9%), fewer concurrent acute ischemic strokes (AIS) (22.1% vs. 24.7%), higher NIHSS (mean NIHSS 7 [2-16] vs. 2 [0-5]), extended stays (4 days [2-8] vs. 4 days [2-7]) and increased hospitalization charges ($52,005 [$25,759-$118,806] vs. $43,199 [$24,116-$85,701]); all P&lt;0.05. Within the concurrent AIS group, the CCAD group also exhibited an increased likelihood for IV thrombolysis (10.7% vs. 5.7%) and mechanical thrombectomy (14.9% vs. 3.7%). After propensity score matching for NIHSS and age, the CCAD group was associated with less death (adjusted odds ratio [aOR] 0.41, 95% CI 0.26-0.65, P&lt;0.001) but a similar home discharge rate (aOR 1.15, 95% CI 0.78-1.69, P=0.480) (Figure). Conclusion: Our study underscores distinct comorbidity profiles and treatment patterns between CCAD and VCAD groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.

Successfully Procedure Endovascular Carotid Angioplasty Stent in a Case of Neck Stab Wound with Pseudoaneurysm, Recurrent Transient Ischemic Attack, and Horner Syndrome: A Case Report

Highlight: Uncommon Presentation and Diagnosis: The case report presents a unique and rare clinical scenario involving a 14-year-old boy who sustained a neck stab wound, leading to the development of a pseudoaneurysm within the common carotid artery. Multidisciplinary Approach to Treatment: The case highlights the complexity of managing such casesm where a multidisciplinary approach is paramount. The manuscript underscores the significance of involving neurology, interventional neurology, and vascular surgery teams to provide comprehensive and tailored patient care Efficacy of Endovascular Intervention: The successful outcome of the endovascular carotid angioplasty stent procedure highlights its effectiveness as a treatment option for addresing complex vascular conditions like pseudoaneurysm or dissection of the carotid artery.   ABSTRACT Introduction: Neck stab wounds can lead to various vascular complications, including pseudoaneurysm or carotid artery dissection. Proper diagnosis and management can prevent recurrent strokes. Case: We reported a case of a 14-year-old boy with a previous left neck stab wound who developed recurrent transient ischemic attacks (TIAs) accompanied by Horner's syndrome and headache following a traumatic common carotid artery dissection. An angiographic examination revealed a pseudoaneurysm or dissection of the left common carotid artery. The patient was initially treated with oral anticoagulant therapy, but he continued to experience recurrent TIA. The patient was then treated endovascularly with a carotid angioplasty stent to restore the compromised carotid artery. Following the endovascular procedure, the patient experienced no complications, showed improvement in Horner syndrome, and had no headache. During the follow-up period, the patient had no more TIAs. Conclusion: Endovascular carotid angioplasty stents are an effective and safe way to treat pseudoaneurysm or dissection of the carotid artery, especially in cases presenting with recurrent TIAs and Horner syndrome. The observed clinical improvement following the procedure indicates significant benefits in enhancing the patient's quality of life and preventing complications from recurrent TIA episodes.

[Clinical characteristics and efficacy analysis of various treatments for spontaneous carotid artery dissection].

Objective: To investigate the clinical features of spontaneous carotid artery dissection (SCAD) and the efficacy of different treatment methods. Methods: The clinical data of 164 patients with SCAD who were treated at the First Affiliated Hospital of Zhengzhou University from June 2018 to January 2023 were retrospectively analyzed. There were 127 males and 37 females, with a mean age of (49.5±11.1) years. They were divided into conservative treatment group (n=100) and surgical treatment group (n=64) according to whether they received surgical treatment. Patients were followed at 3, 6, and 12 months after discharge and annually thereafter through outpatient or inpatient visits. The incidence of cerebral ischemic events, cerebral hemorrhage events, and mortality rates during hospitalization and follow-up periods were analyzed in the two patient groups. To examine correlates of revascularization in SCAD, multifactorial logistic regression analysis was used. Results: Of the 164 patients, 18 patients had bilateral SCAD and a total of 182 carotid arteries were included in the study. Ischemic stroke (85 cases, 51.8%) and transient ischemic attack (31 cases, 18.9%) were the main clinical manifestations in SCAD patients. Hypertension (81 cases, 49.4%) and hyperlipidemia (39 cases, 23.8%) were the main comorbidities in SCAD patients. During hospitalization, 100 patients in the conservative treatment group received medication in 113 carotid arteries, no new cerebral ischemic events or symptomatic intracranial hemorrhage events occurred, and no death occurred. A total of 69 carotid arteries were surgically treated in 64 patients in the surgical treatment group. The success rate was 97.1% (67/69). In the surgical treatment group, the proportion of carotid stenosis degree≥90% was 47.8% (33/69), the proportion of type Ⅱ SCAD was 60.9% (42/69), and the proportion discharged from the hospital to receive antiplatelet therapy was 92.8% (64/69), which were higher than those in the conservative treatment group, which were 25.7% (29/113), 45.1% (51/113), and 73.5% (83/113), respectively (all P<0.05). The follow-up time [M(Q1, Q3)] in the conservative treatment group was 24 (13, 34) months, with an 8% (9/113) rate of ischemic events and a 7.1% (8/113) rate of readmission; in the surgical treatment group, the follow-up time was 24 (11, 38) months, and there were no new ischemic events or deaths. The results of multifactorial logistic regression analysis showed that the degree of true luminal stenosis<90% (OR=2.738, 95%CI: 1.067-7.026, P=0.036) and type Ⅰ dissections (OR=2.656, 95%CI: 1.189-5.935, P=0.017) were the correlates of complete revascularization. Conclusions: Ischemic stroke and transient ischemic attack are the main clinical manifestations in patients with SCAD. Pharmacological antithrombotic therapy remains the method of choice, and endovascular treatment after failure of conservative therapy reduces the risk of recurrent long-term cerebral ischemic events and the re-admission rate of patients.

Surgical management of stylocarotid Eagle syndrome in a patient with bilateral internal carotid artery dissection: illustrative case.

Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection. A patient presented with acute aphasia and right-arm weakness. Imaging revealed a left internal carotid artery dissection, which was treated with stenting. Three years later, the patient presented with left-sided weakness, and imaging revealed a new right internal carotid artery dissection. Closer review of the patient's imaging revealed bilateral elongated styloid processes. The patient subsequently underwent staged bilateral styloidectomy and returned to his prior baseline postoperatively. This case report describes a patient with Eagle syndrome who had two internal carotid artery dissections separated by several years. A literature review revealed that styloidectomy is well tolerated in patients with carotid dissection due to Eagle syndrome. Patients with carotid dissection due to Eagle syndrome remain at risk for contralateral dissection, and prophylactic contralateral styloidectomy should be considered.

Non-Fatal Strangulation Injuries: Improving Physician Knowledge and Attitudes

Background and Objective:In the emergency department, providers are expected to evaluate patients who have experienced strangulation resulting from sexual assault or interpersonal violence. Non-fatal strangulation can lead to significant injuries, including carotid artery dissection. Given the prevalence of strangulation injuries, providers must feel confident in their decision-making for this population. Previous educational interventions effectively improved provider knowledge of sexual assault and domestic violence patients, however, no studies have been conducted with the goal of improving provider knowledge about strangulation injuries in this population. We aimed to assess and improve emergency department provider knowledge surrounding nonfatal strangulation injuries.&#x0D; Project Methods:Preintervention and postintervention surveys were administered to emergency department physicians and advanced practice providers assessing both provider comfort and knowledge regarding treatment of survivors of sexual assault, domestic violence, and strangulation. Key content areas included: physician comfort in treating sexual assault survivors, understanding of trauma-informed care, satisfaction with prior training regarding nonfatal strangulation, and physician attitudes. 6 vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-minute, interactive, educational presentation was administered during the pre-existing departmental meeting. Survey responses were collected via email and data was stored in REDCAP. Preintervention and postintervention results were compared via t-tests.&#x0D; Results:There were 22 pre-intervention and 10 post-intervention responses. Median years of practice were 8. Survey participants tended to rate awareness of imaging recommendations and resources, decisionmaking, history taking, and use of trauma-informed care higher than preintervention participants. Postintervention participants tended to answer more clinical vignettes correctly than preintervention participants.&#x0D; Conclusion and Potential Impact:A 15-minute educational intervention was effective in improving provider knowledge, confidence, and comfort in treating patients who have experienced non-fatal strangulation. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.

Endovascular reconstruction of high cervical and long-segment carotid artery dissections with Leo plus stent.

Endovascular reconstruction has emerged as a viable alternative for carotid artery dissections (CADs) that are unresponsive to antithrombotic therapy. However, high cervical and long-segment CADs pose challenges during endovascular treatment due to their distal location and tortuous anatomy. We presented our experiences using endovascular reconstruction with the Leo plus stent for this type of CAD. We conducted a retrospective review of patients with high cervical and long-segment CADs treated using the Leo plus stent. We analyzed patient demographics, clinical presentations, procedural features, complications, and follow-up outcomes. A total of 17 patients (mean age, 48.1years) with 17 CADs were identified. Seven of these dissections were accompanied by pseudoaneurysm. The mean length of the dissection was 5.7cm, and the mean degree of stenosis was 92.3%. A single Leo plus stent was deployed in 15 patients, while another Wallstent carotid stent was used in 2 cases. All stents were successfully positioned in their intended sites. The average degree of residual stenosis was 22.2%. There were no perioperative complications. With a median follow-up duration of 29months, no ischemic stroke events occurred. All but one Leo plus stent remained patent during follow-up, and all 7 pseudoaneurysms had disappeared at the last radiological assessment. Our experience in treating high cervical and long-segment CADs with the Leo plus stent demonstrates that this approach is practical, safe, and effective, as evidenced by long-term observations. The Leo Plus stent appears to be a suitable option for managing this type of CAD.

Transoral and Transesophageal Point-of-Care Ultrasound in the Diagnosis of Bilateral Carotid Artery and Aortic Dissections.

Transoral and Transesophageal Point-of-Care Ultrasound in the Diagnosis of Bilateral Carotid Artery and Aortic Dissections.

Paracentral acute middle maculopathy as the first sign of internal carotid artery dissection

Purpose: It is proposed to present a clinical case of a patient with a paracentral acute middle maculopathy (PAMM) as the first sign of presentation of severe internal carotid artery (ICA) dissection.Methods: An initial basic ophthalmologic examination of the patient was performed, followed by an optical coherence tomography (OCT) and an OCT‐angiography (OCT‐A) of each eye. Finally, the patient was evaluated by a neurologist, performing a cerebral and supra‐aortic trunks (SAT) computed tomography (CT) angiography.Results: We present a 54‐year‐old patient who came to the emergency room complaining of central blurred vision in his left eye (OS) during 24 h. On ophthalmological examination, it is remarkable a visual acuity (VA) of counting fingers at 1 m in OS. Eye fundus (EF) of OS showed small oval whitish macular lesions. Macular OCT of OS revealed hyperreflective bands in the internal nuclear layer (INL) and OCT‐A showed areas with low flow at deep capillary plexus (DCP) and macular vascular density (MVD) parameters decreased compared to the right eye (OD). During the examination, the patient began to feel a slight loss of strength in his right hemibody with dizziness, so he was explored by a neurologist and a cerebral and SAT CT angiography was performed, which reported severe left ICA dissection with an area of hypoperfusion in the territory of the left middle cerebral artery, but without intracranial vascular occlusion. Since there was no image of occlusion and given the mild neurological symptoms, endovascular treatment was rejected and anticoagulation with enoxaparin was established. Two months later, VA of OS improved to 1, with no significant lesions in the EF. The OCT of OS showed a slight thinning of the INL and the OCT‐A revealed a greater flow in the DCP with better MVD values.Conclusions: This entity should be considered in patients with visual disturbances. PAMM may be the first sign of ICA pathology.

Placement of Endovascular Stent for Reperfusion of Cerebral Infarct After Pediatric Traumatic Internal Carotid Artery Dissection

Placement of Endovascular Stent for Reperfusion of Cerebral Infarct After Pediatric Traumatic Internal Carotid Artery Dissection