Spontaneous Carotid Artery Dissection: Case Reports and Review of the Literature

Abstract

A review of the authors' experience with spontaneous carotid artery dissections and a comparison of their management strategies and outcomes with a review of the recent literature are presented. A retrospective chart analysis revealed 5 cases over the past nine years. All were treated in a conservative fashion. Two underwent anticoagulation, 2 received antiplatelet therapy, and 1 was merely observed. Their ages ranged from thirty-eight to eighty-three and all were men. Four of the 5 (80%) went on to an uneventful recovery. One patient receiving anticoagulation developed total occlusion of the left internal carotid artery associated with an acute stroke.Angiography is the gold standard for diagnosis, but the role of duplex ultrasound for diagnosis and follow-up has strengthened.Of patients with spontaneous carotid artery dissection, 85-90% have an uneventful recovery, and surgical intervention is rarely indicated.