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Mechanism of ischemic infarct in spontaneous carotid dissection

D H Benninger1, D Georgiadis, C Kremer

  • 1Department of Neurology, University Hospitals of Zürich, Switzerland.

Stroke
|February 6, 2004
PubMed

Insights

Stroke in spontaneous cervical internal carotid artery dissection (ICAD) is primarily caused by thromboembolism, not hemodynamic changes. This finding clarifies the essential stroke mechanism in ICAD patients.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Radiology

Background:

  • Spontaneous dissection of the cervical internal carotid artery (ICAD) is a significant cause of stroke in younger adults.
  • The underlying mechanism of stroke in ICAD, whether thromboembolic or hemodynamic, remains debated.

Purpose of the Study:

  • To investigate the primary mechanism of ischemic stroke in patients with spontaneous cervical internal carotid artery dissection (ICAD).
  • To differentiate between thromboembolic and hemodynamic causes of stroke in the context of ICAD.

Main Methods:

  • Retrospective analysis of prospectively collected brain CT, MR, and ultrasound data from 130 patients with 131 ICADs.
  • Exclusion of patients with inappropriate temporal bone windows or those treated with thrombolysis.
  • Evaluation of infarct patterns and vascular findings, including stenosis and occlusion.

Main Results:

  • All analyzed patients presented with territorial infarcts, predominantly affecting the middle cerebral artery (MCA) territory (99%).
  • The pattern and extent of infarction were not significantly influenced by vascular findings such as MCA stenosis, occlusion, or degree of internal carotid artery (ICA) obstruction.
  • No correlation was found between hemodynamic factors and the observed infarct patterns.

Conclusions:

  • Thromboembolism is identified as the essential stroke mechanism in spontaneous cervical internal carotid artery dissection (ICAD).
  • Hemodynamic compromise is not the primary driver of infarction in this patient cohort.
Abstract

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