title: Surgical treatment of spontaneous common carotid dissection: a case report.
abstract: BACKGROUND
  Cervical carotid dissection is more common in extracranical vessel: internal carotid artery dissection (ICAD) is typical, vertebral artery dissection is uncommon, common carotid artery dissection (CCAD) is rare and even a more rare cause of ischemic stroke. Cervical artery dissections account up to 20-25% of ischemic strokes in young patients. Isolated and spontaneous common carotid artery dissection without aortic damage is unique. Indeed in the Literature 8 cases were identified. MRI and CTA were the most commonly used for diagnosis and follow-up.
  
  
  METHODS
  A 67-year-old came to our observation reporting burning pain in the right latero-cervical region in supine position, irradiated in the temporal region and recurrent episodes of migraine with aura (scintillating scotoma), in the last 3 months. The last Doppler Ultrasound control, performed after the onset of symptoms, showed an highlighted dissection wall with double lumen at the origin of the bulb and the internal carotid artery on the right. Aortic arch arteriography confirmed the diagnosis. The patient underwent surgery (longitudinal arteriotomy, removing four miointimal flaps, fastening the distal common carotid artery with 3 Kunlin's points).
  
  
  RESULTS
  Any neurological or vascular problems after surgery were noticed.
  
  
  CONCLUSIONS
  The pathogenesis can be related to a combination of an intrinsic weakness in the arterial wall and an external trigger. The diagnosis of CAD is made with MRI (78.0%), conventional angiography (31.1%), CTA (14.7%), and ultrasound (11.3%).
  
  
  CONCLUSIONS
  No evidence-based guidelines exists for treatment of CCAD. In our patient surgical CEA treatment was the optimal solution.
authors.forename: Bruno
authors.initials: B
authors.lastname: Salvati
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Tesori
authors.forename: Federica
authors.initials: F
authors.lastname: Lombardo
authors.forename: Claudia
authors.initials: C
authors.lastname: Donello
authors.forename: Karen Jeanette
authors.initials: KJ
authors.lastname: Lange
authors.forename: Raffaele
authors.initials: R
authors.lastname: Capoano
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery*; D005260:Female; D006801:Humans