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Progressive symptomatic carotid dissection treated with multiple stents.

Alessandra Biondi¹, Jeffrey M Katz, Janardhan Vallabh

¹Department of Radiology, New York Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY 10021, USA.

|August 16, 2005

Summary

Multiple stents successfully treated a spontaneous internal carotid artery dissection extending to the brain, offering a new option for complex cases unresponsive to standard therapies.

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Area of Science:

Vascular Neurology
Interventional Neuroradiology
Cardiovascular Surgery

Background:

Internal carotid artery (ICA) dissection is a significant cause of stroke in young adults.
While anticoagulation and antiplatelet therapy are standard, they can fail or be contraindicated.
Endovascular stent-assisted angioplasty is an option for extracranial ICA reconstruction in select cases.

Observation:

A 48-year-old patient presented with symptomatic spontaneous carotid dissection extending from the cervical to the supraclinoid ICA segments.
Despite anticoagulant therapy, the dissection progressed, leading to transient ischemic attacks (TIAs).
The patient underwent endovascular treatment with 5 tandem stents deployed from the terminal ICA to the cervical segment.

Findings:

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Post-procedure angiography showed successful luminal diameter reconstitution of the ICA.

The patient experienced clinical improvement with resolution of TIAs.

At 8-month follow-up, the vessel remained patent with mild myointimal hyperplasia and a normal neurological exam.

Implications:

This case demonstrates the efficacy of multi-stent endovascular treatment for extensive, spontaneous ICA dissection.
The successful outcome, including the distal supraclinoid segment, expands treatment options for complex carotid dissections.
This approach offers a viable alternative when medical management fails or is not feasible.