Long-term outcomes of internal carotid artery dissection

Abstract

Most cervical carotid dissections can safely be conservatively managed, with the majority achieving anatomic and symptomatic resolution, with low rates of recurrence over long-term follow-up.

Two Cases of Intracranial Internal Carotid Artery Dissection Presenting with Ischemic Stroke

“…Although the ischemic focus in the right basal ganglia became clearer on MRI with DWI performed the next morning, neurological symptoms were alleviated. DSA performed 11 days after the onset showed satisfactory 4 In the lateral view of DSA of the right internal carotid artery performed 11 days after the onset, satisfactory remodeling of the internal carotid artery was observed.…”

“…1,3,[5][6][7] There are two main patterns of onset, that is, with hemorrhage or ischemia/infarction, but only headache is observed without neurological symptoms in some patients. 1,4,7,8) Although there have been a few sporadic reports regarding idiopathic 6 On DSA (lateral view of the left internal carotid arteriography) performed 18 days after the onset, the vessel delineation was relatively well despite irregularity of the wall in the dissected area of the left internal carotid artery.…”

“…[2][3][4][5][6][9][10][11][12][13][14][15] Concerning internal treatments, indications of antithrombotic treatment still remain controversial. 1,3,4) Although there have been reports that antithrombotic therapy should be avoided, because there is a risk, although rare, of subarachnoid hemorrhage even in intracranial internal carotid artery dissection presenting with ischemia, there have also been reports that no subarachnoid hemorrhage was observed during the period of anticoagulation therapy. 1,4,5,9) Moreover, even when antithrombotic therapy was performed, its contents varied among reports: antiplatelet therapy was performed in some, anticoagulant therapy in others, and combined therapy in still others.…”

“…1,3,4) Although there have been reports that antithrombotic therapy should be avoided, because there is a risk, although rare, of subarachnoid hemorrhage even in intracranial internal carotid artery dissection presenting with ischemia, there have also been reports that no subarachnoid hemorrhage was observed during the period of anticoagulation therapy. 1,4,5,9) Moreover, even when antithrombotic therapy was performed, its contents varied among reports: antiplatelet therapy was performed in some, anticoagulant therapy in others, and combined therapy in still others. [2][3][4][5]7,9) According to the Japanese Guidelines for the Management of Stroke 2015, "antithrombotic therapy (anticoagulant or antiplatelet therapy) may be considered in the acute period of even intracranial artery dissection presenting with ischemia (grade C1).…”

“…1,2) In the acute period, approaches including conservative treatment and endovascular treatment have been reported, but no standard approach has been established due to the scarcity of patients and lack of a large amount of data. [1][2][3][4] In this paper, we report two cases of intracranial internal carotid artery dissection presenting with ischemic stroke with a review of the literature.…”