Endovascular treatment of traumatic dissection of bilateral internal carotid artery: Case report and review of literature

Solapas principales

Maranha L.1, Koppe G.2, Demartini Z.3, Marinho L.4, Ferraresi S.5, Silva M.5

 

ABSTRACT:

Internal carotid artery dissections are a common cause of subarachnoid hemorrhage and stroke in young patients. Traumatic etiology is more common than spontaneous. Conservative treatment with anticoagulant and antiplatelet therapy is indicated in most cases. When there is progression of the symptoms and of the dissection with intracranial extension refractory to medication, endovascular procedures should be considered.

A case of a young female with post-traumatic bilateral dissection of the internal carotida artery successfully treated by endovascular approach is presented based on retrospective analysis of the patient’s medical records and compared with a literature review.

There are few reports in the literature describing endovascular therapy for bilateral internal carotid artery dissections. Most of them are related to traumatic etiologies and affect young patients. Simultaneous bilateral carotid angioplasty does not increase the complication rates in comparison to unilateral consecutive approach and it seems to be a better choice for the treatment of similar cases. Conservative treatment, even effective, can allow rapid neurological deterioration in bilateral internal carotid dissection. Immediate endovascular intervention must prevent brain damage and it is in full technical development to approach this situation. Randomized and controlled prospective studies with larger numbers of cases are needed to establish the best treatment.

 

Keywords: Internal Carotid Artery Dissection; Stents; Blood Vessel Prosthesis; Cerebrovascular Trauma; Carotid Artery Injuries.

 

 

  1. Neurosurgeon and Fellow in Interventional Neuroradiology in Hospital UniversitárioCajuru (HUC) – Curitiba – Paraná – Brazil.
  2. Chief of Interventional Neuroradiology of HUC.
  3. Neurosurgeon and Neuroradiologist of HUC.
  4. Resident in Neurosurgery at HUC.
  5. Academic of Medicine in Pontifícia Universidade Católica do Paraná (PUC-PR) – Curitiba – Paraná –Brazil. 

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