Korean J Radiol.  2001 Mar;2(1):52-56. 10.3348/kjr.2001.2.1.52.

Treatment of Internal Carotid Artery Dissections with Endovascular Stent Placement: Report of Two Cases

• Lee DH
• Hur SH
• Kim HG
• Jung SM
• Ryu DS
• Park MS

• KMID: 754123
• DOI: http://doi.org/10.3348/kjr.2001.2.1.52

Abstract

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.

Keyword

Carotid arteries; Carotid arteries, angiography; Carotid arteries, dissection; Carotid arteries, transluminal,angioplasty

MeSH Terms

Adult
Carotid Artery Injuries/complications
Carotid Artery, Internal, Dissection/etiology/radiography/*therapy
Case Report
Cerebral Angiography
Human
Male
*Stents

Figure

• 

  Fig. 1 Case 1 A. Lateral angiogram of right common carotid artery shows occlusion of its proximal internal branch. Focal dimpling (black arrow) of the posterior aspect indicates partial filling of false lumen by thrombus (small arrows). Distal true lumen has collapsed, with linear filling by contrast media. B. Left internal carotid angiogram shows complete occlusion of proximal segment of right middle cerebral artery, suggesting thromboembolic occlusion. C. Follow-up angiogram obtained 20 days after initial angiography shows partial recanalization of true lumen. A thick dissecting flap is present (arrows) and the dilated false lumen persists. D. Angioplasty was performed 35 days after injury, and a self-expandable metallic stent is seen. E. After angioplasty using a stent, true lumen regained its original diameter. The false lumen, now smaller, may be observed behind the stent. Thirty-five days after stent placement, patency was assessed with CT and the false lumen was no longer visible (not shown).

• 

  Fig. 2 Case 2 A. Initial angiogram of left internal carotid artery demonstrates a focal stenosis of the subpetrosal portion of the artery, associated with a dissecting aneurysm (arrows). The aneurysmal sac is restricted by the bony canal of that portion. B. A balloon-expandable stent was inserted, but is barely visible due to the relatively poor radiopacity and surrounding bony structures. C. Luminal patency of the dissected segment is improved substantially after stent placement, and the aneurysmal sac is much smaller. D. Follow-up angiography was performed 65 days after stent placement. The arterial lumen is well preserved, though the aneurysmal sac is still partly filled. After stent placement, the patient was asymptomatic.

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