The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base

Downer, Jonathan; Nadarajah, Mahendra; Briggs, Eliza; Wrigley, P. F. M.; McAuliffe, William

doi:10.1111/1754-9485.12170

Cited by 23 publications

(16 citation statements)

References 20 publications

(27 reference statements)

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“…This may be due to wall stress increases in the intima in this region due to head movements [5,6]. However, in 1 case series, 49.0% of carotid dissections were only in the distal third of the internal carotid artery, 96.1% involved the distal two-thirds, with only 3.9% originating in the proximal one-third [7]. In another study, based on computed tomography, MR or digital subtraction angiography, dissection at segment III (corresponding with the first and second cervical vertebrae) was the most common site (37.5%) of carotid artery dissection during trauma, while in spontaneous dissection, segment I (origin of the vessel to the fifth cervical vertebrae) was the most common site (55%) [8].…”

Section: Discussionmentioning

confidence: 93%

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

et al. 2020

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Cervical artery dissection is a rare complication of head and neck trauma. Though it is an infrequent cause of ischaemic stroke, it is more common among the young with cerebral ischaemia. The usual location of carotid dissection is just beyond the carotid bulb. We report a case of post-traumatic internal carotid dissection that began at the base of the skull after blunt head trauma from a road traffic accident. The patient is a 25-year-old right-handed lady who, 2 days after the accident, developed dysphasia and right-sided limb weakness. She had no significant past medical history. Magnetic resonance imaging (MRI) showed acute ischaemic stroke in the internal watershed regions of the left cerebral hemisphere. MR angiogram revealed focal near-occlusion of the left internal carotid artery at the base of the skull just prior to its entry into the petrous temporal bone. There were no skull fractures. She progressed despite anticoagulation. The location of the site of dissection at the base of the skull is likely due to stresses on the carotid intima at this point during flexion-extension-rotation that occurs during head injury, as this is where the internal carotid artery is tethered to the skull. Rapid recognition of symptoms of cerebral ischaemia among patients with blunt head trauma is needed to allow prompt investigation and institution of relevant therapies.

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Section: Discussionmentioning

confidence: 93%

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

et al. 2020

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“…10) Dissection has also been reported to occasionally start 20–30 mm distal to the carotid bifurcation. 11,12) We need to keep this distance in mind when manipulating the microguidewire.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bilateral Cervical Internal Carotid Artery Dissection Treated with Simultaneous Bilateral Carotid Artery Stenting: A Case Report

Ishigami

Ota

2019

NMC Case Report Journal

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Spontaneous cervical internal carotid artery dissection (CICAD) is occasionally treated with conservative management, mainly using antithrombotics. However, we have to consider emergency interventions for bilateral CICAD occurring simultaneously and accompanied by progressive cerebral ischemia. A 46-year-old woman was brought to our hospital with a complaint of left-handed clumsiness, blurred vision in the left eye, and right hemiplegia. Acute cerebral infarction in bilateral cerebral hemispheres was evident on brain magnetic resonance imaging. Bilateral internal carotid arteries were barely visible on time-of-flight magnetic resonance angiography. Subsequent cerebral angiography demonstrated that cervical internal carotid arteries on both sides were tapered off immediately after the bifurcations, indicating CICAD. Despite management with intravenous antithrombotic agents and hydration, neurological status gradually deteriorated. After insertion of a transvenous temporary pacemaker, we performed simultaneous bilateral carotid artery stenting (sbCAS) 3 days after admission. The patient first suffered slight right-sided hemiplegia and hoarseness, but symptoms resolved after rehabilitation, and modified Rankin Scale was 0 as of 2 years after the procedure. Bilateral CICAD causes severe insufficiency of cerebral blood flow, and symptoms often persist even after administration of antithrombotic agents. In such refractory cases, early intervention should be considered, and sbCAS can be safely performed. During the procedure, a transvenous temporary pacemaker maintains hemodynamic stability and might be a favorable option.

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“…Wall stress of the intimal side of the ICA increased at the skull base and the cranial edge of the carotid sinus. Downer et al 5 reported that 36 (94.7%) of 38 vessels had maximum mural hematoma thickness in the distal third of the ICA and that fixation of the ICA at the cranial base was related to the pathology of ICA dissection. In the present case, the left ICA was fixed at the skull base and at the ICA portion compressed by the osteophyte and was highly stretched between these two portions during neck rotation.…”

Section: Discussionmentioning

confidence: 99%

Extracranial internal carotid artery dissection caused by compression from a giant osteophyte due to atlantoaxial osteoarthritis: case report

Ikedo

Nakamura

Sano

et al. 2017

Journal of Neurosurgery: Spine

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Deformed osseous structures have been reported as rare causes of extracranial internal carotid artery (ICA) dissection, including the styloid process and the hyoid bone. Here, the authors describe the first known case of symptomatic ICA dissection caused by a giant osteophyte due to atlantoaxial osteoarthritis. The left ICA was fixed at the skull base and at the ICA portion compressed by the osteophyte, and it was highly stretched and injured between the two portions during neck rotation. The patient was successfully treated with ligation of the affected ICA following balloon test occlusion. Atlantoaxial osteoarthritis should be considered in the differential diagnosis of ICA dissection in patients with a severely deformed cervical spine.

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The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base

Cited by 23 publications

References 20 publications

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

Spontaneous Bilateral Cervical Internal Carotid Artery Dissection Treated with Simultaneous Bilateral Carotid Artery Stenting: A Case Report

Extracranial internal carotid artery dissection caused by compression from a giant osteophyte due to atlantoaxial osteoarthritis: case report

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