Traumatic Carotid Artery Dissection Research Articles

Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature.

Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.

The Silent Threat: Unraveling the Rare Catastrophic Complication after Elective Cranioplasty

AbstractAlthough cranioplasty seems to be a simple procedure, fatal complication of development of diffuse severe cerebral edema following cranioplasty although unusual have been reported in a few cases. The mechanism for this occurrence is still speculative. A 38-year-old male patient presented with a history of having undergone left decompressive hemicraniectomy following a road traffic accident with traumatic left intracranial internal carotid artery dissection leading to anterior cerebral artery and middle cerebral artery territory infarct and endovascular embolization of traumatic type 1 left caroticocavernous fistula. The preoperative computed tomography scan of the brain revealed left frontotemperoparietal craniectomy defect with sunken flap and diffuse encephalomalacia with gliosis of the entire left cerebral hemisphere. Immediately following an uneventful cranioplasty surgery with titanium mesh, the patient developed severe hypotension and dilated fixed pupils. Postoperative imaging revealed diffuse severe cerebral edema in bilateral hemispheres with a significant midline shift toward the ipsilateral (left) side, that is, toward the side of cranioplasty. The patient immediately underwent removal of the titanium mesh, and despite all efforts, the patient had a fatal outcome on postoperative day 5. Although this type of fatal complication of diffuse severe cerebral edema is rare in postcranioplasty patients, neurosurgeons must be aware of this complication and close monitoring postprocedure is important, especially in patients with a large craniectomy defect and sunken skin flap.

Traumatic carotid artery dissection in polytrauma: is conservative treatment an adequate strategy? A case report

We present the case of a 24-year-old man, involved in a car accident, with a traumatic right carotid artery dissection Grade II Blunt CerebroVascular Injury (BCVI) according to the Eastern Association for the Surgery of Trauma (EAST). The patient arrived at our hospital without neurological symptoms and was then admitted to the Intensive Care Unit (ICU) for neurological monitoring; antithrombotic and antiplatelet therapy was initiated and in line with current literature, no routine endovascular treatment was performed. Twenty-four hours post-trauma, the patient required an urgent abdominal surgical intervention under general anesthesia. Upon awakening, he presented with left hemiplegia. The CT scan revealed hypodensity in the front-insular region prompting an urgent endovascular procedure. Fourteen days post trauma the patient was discharged from the Stroke Unit with an unchanged neurological performance, despite receiving appropriate treatment for Grade II BCVI, as recommended in current literature. Our patient developed a severe neurological disability. Further discussions are needed.

Images in Vascular Medicine: Cerebral infarction secondary to traumatic external carotid artery dissection.

Images in Vascular Medicine: Cerebral infarction secondary to traumatic external carotid artery dissection.

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.

Common carotid artery dissection from sportive choking

Tandem occlusions of the anterior circulation refer to the simultaneous presence of a cervical carotid artery occlusion or high-grade stenosis and an ipsilateral large vessel occlusion involving the intracranial internal carotid artery, M1 or proximal M2 middle cerebral artery. Whilst carotid occlusion usually results from progressive atherosclerotic disease, in younger individuals it may arise secondary to a dissection for which there are multiple aetiologies, with trauma being an important cause in patients having a relevant history. We present a rare case of traumatic left common carotid artery dissection in a young professional Jiu-Jitsu fighter presenting with delayed stroke symptoms and angiographic findings of a tandem occlusion. This case was successfully managed with endovascular clot retrieval and antiplatelet medication.

Central retinal artery occlusion secondary to presumed traumatic carotid artery dissection in a healthy child

PurposeTo describe a rare case of a 13 years-old healthy child that presented CRAO secondary to carotid artery dissection, which occurred after a neck rotation movement.MethodsCase report with prospective literature review.PatientsOne patient described in the case report.ResultsNot applicable.Discussion/conclusionInternal carotid artery dissection is a rare condition, specially in children, that can lead to serious cerebral-ocular ischemic events. It may occur due to direct vessel trauma or spontaneously. Prompt imaging screening is of paramount importance because early antithrombotic treatment or surgical intervention may significantly reduce the incidence of devastating ischemic events, such as stroke or central retinal artery occlusion.

Atypical Presentation of Traumatic Pediatric Carotid Artery Dissection: A Case Report.

IntroductionCarotid artery dissection is a rare but serious condition manifesting with signs and symptoms that closely overlap with other more benign medical diagnoses. This vascular injury, however, can result in debilitating sequelae, including thromboembolic cerebrovascular accidents.Case ReportWe describe the atypical presentation of a healthy eight-year-old male who presented to the emergency department (ED) with generalized abdominal pain and non-bloody, non-bilious emesis. These symptoms occurred nine days after he sustained blunt head trauma after a non-syncopal fall from standing while playing hockey. He was initially diagnosed with gastroesophageal reflux disease and constipation and was discharged home. The following day he developed an acute headache followed shortly by gait ataxia, prompting a return visit to the ED. Imaging of the head and neck revealed a left internal carotid artery dissection. The patient was started on intravenous unfractionated heparin and admitted to the hospital. He was later discharged symptom-free on therapeutic enoxaparin for eight weeks, followed by daily aspirin therapy.ConclusionPediatric trauma patients, especially those sustaining insult to the head and cervical spine, are at risk for craniocervical arterial injuries. This rare but dangerous pathology often manifests in a non-specific, delayed fashion making it a challenging diagnosis for physicians to make on the initial medical encounter.1,2 Maintaining a high clinical suspicion for carotid artery dissection is required to make this diagnosis and should guide a thorough history, physical examination, and appropriate imaging in order to improve patient morbidity and mortality. This case emphasizes key clinical features and risk factors of this disease that may help emergency clinicians promptly recognize and treat this entity.

Delayed Blunt Traumatic Carotid Artery Dissection After a Scooter Accident: A Case Report.

IntroductionTraumatic carotid artery dissections (CAD) are rare but produce potentially devastating injuries. Most patients develop symptoms within 72 hours of traumatic injury.Case ReportWe report the case of a 33-year-old, previously healthy male who presented to the emergency department for evaluation of transient, right-sided facial droop with visual changes. His symptoms began 12 days after falling off a scooter. Imaging revealed an extracranial internal CAD.ConclusionSymptoms of CAD may present weeks after blunt trauma, making clinical diagnosis difficult. Clinicians must have high suspicion for vascular injury and consider neuroimaging in cervical flexion/extension injuries.

Carotid Endarterectomy for Effective Management of Traumatic Extracranial Carotid Artery Dissection following a Penetrating Neck Injury : A Case Report

Carotid Endarterectomy for Effective Management of Traumatic Extracranial Carotid Artery Dissection following a Penetrating Neck Injury : A Case Report

Traumatic intracranial internal carotid artery dissection and pseudoaneurysm presenting as oculomotor nerve palsy

Traumatic intracranial internal carotid artery dissection and pseudoaneurysm presenting as oculomotor nerve palsy

A unique temporary collateral pathway between carotid-vertebrobasilar arteries in a carotid dissection patient

BackgroundIn adults, the anastomosis between carotid and vertebrobasilar arteries is usually the posterior communicating artery, sometimes the primitive trigeminal artery. In this case, the basilar artery fed the internal carotid artery through the pontine-to-tentorial artery anastomosis after severe stenosis from traumatic carotid dissection.Case presentationA 32-year-old female was diagnosed with ischemic stroke caused by traumatic carotid artery dissection. Aspirin (100 mg/day) and clopidogrel (75 mg/day) were prescribed. Digital subtraction angiography performed 6 days after stroke onset showed a dissection in the cervical segment of left internal carotid artery with severe local stenosis, and a collateral pathway from BA to the cavernous segment of internal carotid artery through the lateral pontine and tentorial artery. Without interventional therapy, clinical symptoms improved significantly within 10 days after onset. At 3-month follow-up, left common carotid artery angiography showed the stenosis had been significantly improved with a residual aneurysm. There was no collateral pathway between carotid-vertebrobasilar arteries, and a residual small artery originated from the posterior vertical segment of cavernous internal carotid artery. The small artery was clearly visualized by 3-dimensional rotational angiography and identified the tentorial artery.ConclusionTo the author’s knowledge, this is the first report of a collateral pathway between carotid vertebrobasilar arteries through the pontine-to-tentorial artery anastomosis. Meanwhile, tentorial artery origination directly from the cavernous segment of internal carotid artery is rare and easily mistaken for persistent primitive trigeminal artery. 3-dimensional rotational angiography can provide sensitive and accurate diagnostic assessment of the small artery, and may be a useful tool for screening of abnormal small arteries.

Traumatic carotid artery dissection: Early treatment by stenting is effective

Traumatic carotid artery dissection: Early treatment by stenting is effective

Traumatic Carotid Artery Dissection in Teenagers After Football Injuries (P6.218)

Traumatic Carotid Artery Dissection in Teenagers After Football Injuries (P6.218)

Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients.

PurposeThe aim of this study was to evaluate the true incidence of cervical artery dissections (CeADs) in trauma patients with an Injury Severity Score (ISS) of ≥16, since head-and-neck computed tomography angiogram (CTA) is not a compulsory component of whole-body trauma computed tomography (CT) protocols.Patients and methodsA total of 230 consecutive trauma patients with an ISS of ≥16 admitted to our Level I trauma center during a 24-month period were prospectively included. Standardized whole-body CT in a 256-detector row scanner included a head-and-neck CTA. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed retrospectively in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD).ResultsOf the 230 patients included, 6.5% had a CeAD, 5.2% had a CAD, and 1.7% had a VAD. One patient had both CAD and VAD. For both, CAD and VAD, mortality is 25%. One death was caused by fatal cerebral ischemia due to high-grade CAD. A total of 41.6% of the patients with traumatic CAD and 25% of the patients with VAD had neurological sequelae.ConclusionMandatory head-and-neck CTA yields higher CeAD incidence than reported before. We highly recommend the compulsory inclusion of a head-and-neck CTA to whole-body CT routines for severely injured patients.

Endovascular Stenting for the Treatment of an Initially Asymptomatic Patient with Traumatic Carotid Artery Dissection.

Endovascular Stenting for the Treatment of an Initially Asymptomatic Patient with Traumatic Carotid Artery Dissection.

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury

Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary: A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages: We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.

動脈解離により血管腔が間歇的に閉鎖し，一過性脳虚血症状を繰り返したと考えられた頸部内頸動脈解離の1 例

症例は66 歳の女性．30 秒～1 分間程度持続する一過性の右上肢脱力発作を繰り返し発症した．脳血管撮影により頸部頸動脈解離の診断に至った．患者には，約1 カ月前に頸部への鈍的外傷歴があった．急性期の脳虚血巣はMRI では認められず，MRI および造影CT において解離病変部内に明らかな血栓が同定できないこと，非脳虚血発作時の脳血流検査で脳血流低下や脳血流予備能低下も認められないことから，当初，脳虚血発作の発症機序を特定できなかった．血管内視鏡による病変部観察の結果，解離した血管壁が可動性を有するフラップ形状を呈しており，偽腔内へ流入する血流により解離フラップが血管腔を閉塞するように上昇運動する状態が観察されたことから，解離血管壁が間歇的に血管腔を閉鎖することが本症例の病態生理と推測された．頸動脈ステント留置術により解離血管壁を固定した結果，脳虚血症状は消失した．

Cerebral Infarct due to Traumatic Carotid Artery Dissection

A patient aged 48 years was admitted to our emergency department with right motor deficit and speech disorder. On neurologic examination, dysarthria, right hemiparesis, and rightside Babinski reflex were found. The patient’s brain computerized tomography (CT) was normal. During hospitalization, he complained of neck pain spreading to the head and was questioned about trauma for the differential diagnosis of dissection. He had been attacked on the left side of his neck during a fight the day before. Twelve hours later, the patient’s symptoms continued to increase and dizziness developed. Diffusion-weighted images revealed a hyper-intensity in the region of the left middle cerebral artery, accompanied by low apparent diffusion coefficient signals (Figure 1). Duplex ultrasound was performed and acute thrombosis and stenosis of the left carotid artery was demonstrated. CT angiography revealed thrombus and dissection of the left carotid artery in the neck (Figure 2A, B, C). Treatment was started with low-molecular-weight heparin followed by warfarin. The patient was prescribed warfarin, an oral anticoagulant, for at least 6 months because the radiologic and duplex ultrasound findings did not change or worsen. Although conventional digital subtraction angiography is still the gold standard procedure, noninvasive methods are preferred to decrease the risk of stroke. Duplex ultrasound has limited ability and is the procedure of choice to follow-up the progression of dissection. CT and magnetic resonance angiography with a similar sensitivity and specificity can be used in the diagnosis of dissection (1,2). In conclusion, internal carotid artery dissection is a potentially life-threatening condition and serious cause of stroke in young patients; therefore, early diagnosis is important.