Stent Implantation for Treatment of Symptomatic Spontaneous Cervical Internal Carotid Artery Dissecting Aneurysm. A Case Report

Abstract

Cervical internal carotid dissections are rare. Approximately one third of the cases are associated with pseudoaneurysm. The first-choice management of cervical carotid dissecting aneurysms consists in anticoagulation or antiplatelet therapy. Surgery is typically indicated in cases of failure of conservative therapy with recurrent cerebral ischemic attacks. In recent years, stent implantation has been also employed for the management of patients with carotid dissecting aneurysms whose neurological conditions were refractory to medical treatment. In the present case we describe the treatment of a patient with a carotid dissecting aneurysm, by means of endovascular stent application and provide angiographic control 24 months after the intervention.

Key words

Carotid dissection - pseudoaneurysm - carotid stent - endovascular treatment

References

• 1 Mokri B, Sundt Jr T M, Houser O W, Piepgras D G. Spontaneous dissection of the cervical internal carotid artery.  Ann Neurol. 1986;  19 126-138
• 2 Friedman W A, Day A L, Quisling R G, Sypert G W, Rhoton A L. Cervical carotid dissecting aneurysms.  Neurosurgery. 1980;  7 207-214
• 3 Schievink W I, Piepgras D G, McCaffrey T V, Mokri B. Surgical treatment of extracranial internal carotid artery dissecting aneurysms.  Neurosurgery. 1994;  35 809-815
• 4 Hart R G, Easton J D. Dissection of cervical and cerebral arteries.  Neurol Clin. 1983;  1 155-182
• 5 Guillon B, Levy C, Bousser M G. Internal carotid artery dissection: an update.  J Neurol Sci. 1998;  153 146-158
• 6 Neau J P, Petit E, Gil R. Dissections of cervical arteries.  Presse Med. 2001;  30 1882-1889
• 7 Visheth A G, Marciano F F, David C A, Schievink W I, Zambramski J M, Spetzler R F. Long-term graft patency rates and clinical outcomes after revascularization for symptomatic traumatic internal carotid artery dissection. Clinical study.  Neurosurgery. 1998;  43 761-768
• 8 Bejjani G K, Monsein L H, Laird J R, Satler L F, Starnes B W, Aulisi E F. Treatment of symptomatic cervical carotid dissections with endovascular stents.  Neurosurgery. 1999;  44 755-761
• 9 Liu A Y, Paulsen R D, Marcellus M L, Steinberg G K, Marks M P. Long-term outcomes after carotid stent placement for treatment of carotid artery dissection.  Neurosurgery. 1999;  45 1368-1373
• 10 Perez-Cruet M J, Patwardhan R V, Mawad M E, Rose J E. Treatment of dissecting pseudoaneurysms of the cervical internal carotid artery using a wall stent and detachable coils: case report.  Neurosurgery. 1997;  40 622-626
• 11 Mokri B. Traumatic and spontaneous extracranial internal carotid artery dissections.  J Neurol. 1990;  237 356-361
• 12 Guillon B, Brunereau L, Biousse V, Djouri H, Lévy C, Bousser M G. Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection.  Neurology. 1999;  53 117-122
• 13 Touzé E, Randoux B, Méary E, Arquizan C, Meder J F, Mas J L. Aneurysmal forms of cervical artery dissection: associated factors and outcome.  Stroke. 2001;  32 418-423
• 14 Leys D, Moulin T, Stojkovic T, Begey S, Chavot D. Follow-up of patients with history of cervical artery dissection.  Cerebrovasc Dis. 1995;  5 43-49
• 15 Oishi H, Yoshida K, Oyama M, Tsuji O, Sonobe M. Combination of stenting and coil embolization for carotid artery pseudoaneurysm causing symptomatic mass effect: case report.  No Shinkei Geka. 2002;  30 437-441
• 16 Findlay J M, Ashforth R, Dean N. “Malignant” carotid artery dissection.  Can J Neurol Sci. 2002;  29 378-385
• 17 Binaghi S, Chapot R, Rogopoulos A, Houdart E. Carotid stenting of chronic cervical dissecting aneurysm: a report of two cases.  Neurology. 2002;  59 935-937
• 18 Miyamoto S, Kikuchi H, Karasawa J, Kuriyama Y. Surgical treatment for spontaneous carotid dissection with impending stroke: case report.  J Neurosurg. 1984;  61 382-386
• 19 Sundt Jr T M, Pearson B W, Piepgras D G, Houser O W, Mokri B. Surgical management of aneurysms of the distal extracranial internal carotid artery.  J Neurosurg. 1986;  64 169-182
• 20 Schievink W I. Spontaneous dissection of the carotid and vertebral arteries.  N Engl J Med. 2001;  344 898-906
• 21 Mase M, Banno T, Yamada K, Datano H. Endovascular stent placement for multiple aneurysms of the extracranial internal carotid artery: case report.  Neurosurgery. 1995;  37 832-835
• 22 Marotta T R, Buller C, Taylor D, Morris C, Zwimpfer T. Autologous vein-covered stent repair of a cervical internal carotid artery pseudoaneurysm: Technical case report.  Neurosurgery. 1998;  42 408-412
• 23 Roubin G S, Yadav S, Iyer S S, Vitek J. Carotid stent-supported angioplasty: A neurovascular intervention to prevent stroke.  Am J Cardiol. 1996;  78 8-12