Surgical treatment of 50 carotid dissections: Indications and results

Müller, Bárbara; Luther, B; Hort, W; Neumann‐Haefelin, Tobias; Aulich, A.; Sandmann, W.

doi:10.1067/mva.2000.104586

Cited by 152 publications

(83 citation statements)

References 28 publications

(30 reference statements)

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“…Because of the unfavorable results of surgery (5), which are linked to substantial difficulties in preparation of the dissected carotid artery and cranial nerve injury, endovascular strategies are increasingly applied, with corresponding reported outcomes encouraging (6 -18).…”

Section: Further Pointsmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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PURPOSE: To provide evidence for the endovascular repair of patients with extracranial carotid artery dissection. MATERIALS AND METHODS: A comprehensive literature review was performed whereby all studies that reported on the results of endoluminal repair of extracranial carotid artery dissection and provided information about primary technical and clinical success were identified. The Pubmed, Embase, and Medline databases were searched between January 1997 and February 2008 by two independent observers by using combinations of search terms "endovascular repair," "extracranial carotid artery," and "carotid dissection." RESULTS: After studies were selected according to the given criteria, 13 studies were included in our statistical analysis. The number of reported patients was 62, with a total of 63 extracranial carotid artery dissections. The mean patient age was 43.3 years. The mean follow-up period was 15.7 months +/-8.7. Various causes were responsible for the disease, including a blunt neck injury in 28 patients (45%), spontaneous dissection in 21 (37%), and iatrogenic trauma during invasive radiologic procedure in 17.7% patients. The technical success rate was 100% (63 of 63 procedures). The primary and 1-year patency rate of the stents and/or stent-grafts was 100%. The overall major adverse cardiovascular events rate was 11% (seven strokes). The total follow-up mortality rate was 0%. CONCLUSIONS: The current status of the reported cases in the literature regarding the treatment of carotid artery dissection by means of stent placement shows excellent early and 1-year patency rates and a low major adverse cardiovascular event rate. However, further evaluation is necessary to draw robust conclusions.

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Section: Further Pointsmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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“…struction to prevent further ischemic or thromboembolic complications, if medical treatment with 6 months of anticoagulation fails or if CA aneurysms and/or high-grade stenosis persist. 48 In most cases, endovascular treatment has supplanted open surgery as the initial treatment of choice in adults once medical therapy fails. 35,38 Endovascular stenting for carotid atherosclerotic disease was not in use prior to 1989; studies published prior to 1989 may not reflect endovascular stenting as an available treatment option for CAD.…”

Section: Management Optionsmentioning

confidence: 99%

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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Object Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. Methods A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. Results No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. Conclusions As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.

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“…Although minimally invasive techniques are now the preferred treatment modality in these cases, the long-term efficacy and durability of a stent in cases of arterial dissection remain to be determined. 13,14 Patients are usually followed regularly for several months to a year to ensure clinical resolution of symptoms. Serial imaging may also be used to monitor resolution of the mural hematoma and repair of the vessel wall.…”

Section: Treatmentmentioning

confidence: 99%

Dissection of the internal carotid artery causing Horner syndrome and palsy of cranial nerve XII

Kasravi

Leung²,

Silver³

et al. 2010

Canadian Medical Association Journal

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A 61-year-old right-handed man presented with a twoday history of a new headache that had developed gradually several hours after he dived into a lake. The headache, which encompassed the entire left side of the head, had a maximal intensity of 10 out of 10 and was described as dull and constant with mild photophobia. The patient also reported blurry vision in the left eye. In addition, his speech was slurred, and he had difficulty swallowing.There were no carotid or vertebral artery bruits evident on physical examination. Cranial nerve examination demonstrated 2.5-mm ptosis of the left eye; in addition, the diameter of the left pupil was 1 mm smaller than that of the right in dim light (Figure 1). Both pupils were reactive, and there was no relative afferent pupillary defect. The tongue deviated to the left when protruded; there were no fasciculations ( Figure 1). The results of the remainder of the cranial nerve examination were normal, including normal gag response, symmetric elevation of the palate and full power in the sternocleidomastoid and trapezius muscles. The results of motor, sensory, cerebellar and gait testing were unremarkable. Ophthalmoscopy and visual-field testing during a neuro-ophthalmologic consultation did not reveal any additional abnormalities.At this point, the main diagnostic considerations included a cervical mass lesion within the carotid sheath, such as dissection of the carotid artery, which could cause a mass effect on the adjacent ascending sympathetic plexus or on cranial nerve XII at the base of the skull, beyond the point of emergence from the hypoglossal foramen. Such a mass would cause ipsilateral Horner syndrome (see Box 1) and deviation of the tongue. Alternatively, a left-sided lesion of the brainstem Key points• Dissection of the carotid artery should be considered in cases of new unilateral headache in patients with a history of trauma or with accompanying Horner syndrome or cranial nerve palsy.• Computed tomography angiography and magnetic resonance angiography are sensitive diagnostic imaging modalities for carotid artery dissection and should be used before digital subtraction (conventional) angiography.• Magnetic resonance angiography has a higher sensitivity after several days, as the hemoglobin in the mural hematoma of the dissection will have been converted to methemoglobin, which is hyperintense on T 1 -weighted sequences.• Carotid artery dissection may be associated with significant morbidity because of cerebral ischemia and requires prompt treatment with antiplatelet or anticoagulation therapy.

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Surgical treatment of 50 carotid dissections: Indications and results

Cited by 152 publications

References 28 publications

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Dissection of the internal carotid artery causing Horner syndrome and palsy of cranial nerve XII

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