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"Malignant" carotid artery dissection.

J Max Findlay1, Robert Ashforth, Naeem Dean

  • 1Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|December 5, 2002
PubMed
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Aggressive endovascular and microsurgical interventions are crucial for treating severe carotid artery dissection with intracranial embolism, which can cause life-threatening hemispheric ischemia.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Neuroradiology

Background:

  • Carotid artery dissection can lead to occlusion or severe narrowing, causing massive intracranial embolism and life-threatening hemispheric ischemia.
  • Prompt and aggressive treatment is essential to salvage brain tissue and minimize stroke-related disability in critical cases.

Observation:

  • Two middle-aged women presented with spontaneous cervical internal carotid artery (ICA) dissection causing hemiplegia, deviated gaze, and declining consciousness.
  • Treatment involved a combination of intracranial thrombolysis, microsurgical intimectomy/thrombectomy, and endovascular stenting.
  • Techniques included microcatheter navigation through the posterior circulation for intracranial thrombolysis and Fogarty catheter use for thrombectomy.

Findings:

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  • Despite initial occlusions or severe narrowing, aggressive endovascular and microsurgical approaches were successfully employed.
  • Both patients experienced basal ganglionic infarcts, but significant portions of the middle cerebral artery territories were preserved.
  • Patients achieved satisfactory recoveries following the combined treatment strategies.

    • Implications:

    • "Malignant" carotid artery dissection necessitates urgent and aggressive multimodal treatment to prevent devastating neurological deficits.
    • The combination of endovascular and microsurgical techniques offers a viable strategy for managing complex carotid artery dissections with embolic complications.
    • Timely intervention can significantly improve outcomes and preserve neurological function in patients at high risk of hemispheric stroke.