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Updated: Jul 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intra-arterial thrombolysis and stent placement for traumatic carotid dissection with subsequent stroke: a combined,
Jose E Cohen1, John M Gomori, Savvas Grigoriadis
1Department of Neurosurgery, Hadassah Hebrew University Hospital, Jerusalem, Israel; Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Insights
Traumatic carotid dissection can cause stroke. A novel bilateral approach combining intra-arterial fibrinolysis and carotid stenting successfully treated a patient with internal carotid artery dissection and stroke, leading to full recovery.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Traumatic carotid dissection is a significant cause of ischemic stroke.
- Treatment strategies for the stroke complication of carotid dissection are less explored than for the dissection itself.
Observation:
- A 43-year-old patient presented with blunt traumatic internal carotid artery dissection, subocclusive stenosis, and a major cerebral thromboembolic complication.
- A combined, simultaneous intra-arterial fibrinolysis and carotid stenting procedure was performed using a bilateral approach.
Findings:
- The simultaneous bilateral approach allowed immediate initiation of intra-arterial thrombolysis via the contralateral carotid artery.
- Stent-assisted angioplasty of the injured carotid artery was concurrently performed.
- The combined procedure resulted in the complete clinical recovery of the patient.
Implications:
- This simultaneous bilateral approach for treating traumatic carotid dissection with stroke is safe and effective.
- This technique may represent a valuable treatment option for similar complex cases.
- Further investigation into this combined approach is warranted for broader clinical application.
Abstract:
Traumatic carotid dissection is a well-known cause of ischemic stroke and although the treatment of the dissection itself has received some attention in recent years, the treatment of the concomitant stroke has been less investigated. We present a 43-year-old patient with blunt traumatic internal carotid artery dissection associated with subocclusive stenosis and major cerebral thromboembolic complication. Combined, simultaneous intra-arterial fibrinolysis and carotid stenting through a bilateral approach was successfully performed allowing the complete clinical recovery of the patient. Contralateral carotid artery approach allowed the beginning of intra-arterial thrombolysis without delay, while stent-assisted angioplasty of the injured carotid was simultaneously performed. This approach was proved to be safe and effective and may deserve further evaluation.
