title: Therapeutical Options in the Management of Carotid Dissection.
abstract: BACKGROUND
  The best management of carotid artery dissection (CAD) is still controversial ranging from antiplatelet medication to open surgery or endovascular treatment. In this retrospective study, we assessed the safety and efficacy of endovascular stent angioplasty for the treatment of CAD.
  
  
  METHODS
  From February 2006 to February 2016, 44 patients (28 women and 16 men, age range 25-65 years, mean 42) with CAD were included in this study. The internal carotid artery dissection was spontaneous in 32 patients and posttraumatic in the remaining 12 (in 1 case, it was bilateral). Twenty-eight patients were treated by intravenous heparin infusion followed by standard oral anticoagulation. Carotid artery stenting was carried out in 14 cases with recurrent ischemic events despite optimal anticoagulation management. Two patients with an open trauma of the neck were submitted to a common carotid to internal carotid bypass (CC-CI bypass). The follow-up ranged from 6 to 60 months and was performed clinically first and with Doppler ultrasound and computed tomography or magnetic resonance at 6, 12, and 24 months.
  
  
  RESULTS
  Follow-up ranged from 6 to 60 months. Mortality was nil. All patients submitted to the endovascular or surgical management had an immediate relief of their neurologic symptoms with no procedure-related complications. No thrombosis or restenosis of the CC-CI bypass or of carotid artery stents occurred during intraoperative and postoperative period and follow-up.
  
  
  CONCLUSIONS
  An alternative therapeutic option is mandatory in a subset of patients regarded as being at high risk for stroke because anticoagulant therapy was either contraindicated or failed clinically with recurrent transient ischemic attacks/transient symptoms associated with brain infarction. In these selected cases, endovascular stent placement seems to be a safe and effective option to restore vessel lumen integrity and prevent stroke.
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Martinelli
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Venosi
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Jamila
authors.initials: J
authors.lastname: BenHamida
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alban
authors.initials: A
authors.lastname: Malaj
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Belli
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy. Electronic address: francesco_irace@hotmail.it.
authors.forename: Francesco Giosue'
authors.initials: FG
authors.lastname: Irace
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gattuso
authors.affiliation: Department of Biotechnology and Medical-Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gossetti
authors.affiliation: Unit of Vascular Surgery, Department "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Irace
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D020520:Brain Infarction / Q000209:etiology; D020212:Carotid Artery Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D000925:Anticoagulants; D006493:Heparin