Endovascular management of acute carotid artery dissection with a waxing and waning neurological deficit.
OBJECTIVE
To evaluate the feasibility and efficacy of emergent carotid stenting for an acute internal carotid artery (ICA) dissection.


METHODS
A 51-year-old man was admitted to our emergency department's stroke unit 1 hour after the onset of left hemiparesis. Computed tomographic and transcranial Doppler scans showed no pathological findings, but the color Doppler study detected a double lumen in the right carotid bifurcation extending to the proximal ICA. Within the first 2 hours after admission, the patient's neurological status began to fluctuate; the NIH Stroke Scale (NIHSS) and Rankin scores evaluated each hour after admission ranged from 0 to 12 and from 0 to 3, respectively. Emergency carotid angiography confirmed the dissection of the bulb and proximal right ICA, which prompted implantation of 2 Wallstents from the internal to common carotid artery. Forty-eight hours later, the patient was almost totally asymptomatic with an NIHSS score of 1 and a Rankin score of 0; he was discharged on postoperative day 3. At 3 months, the patient was free of neurological symptoms and the stented carotid artery was patent.


CONCLUSIONS
In patients with fluctuating neurological signs and symptoms consistent with carotid artery dissection that are refractory to medical therapy, a stent can be placed to prevent permanent neurological deficits provided that the anatomical conditions are suitable.
Sbarigia
Enrico
E
Cattedra di Chirurgia Vascolare, Università degli Studi di Roma La Sapienza, Italy. sbarigia@pbxfreenet.it
Battocchio
Cesare
C
Panico
Maria A
MA
Zaccagnini
Davide
D
Salvatori
Filippo M
FM
Argentino
Corrado
C
D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents