Computed Tomography Perfusion Can Guide Endovascular Therapy in Bilateral Carotid Artery Dissection

  • Isuru Induruwa Addenbrookes Hospital NHS Foundation Trust
  • Chloe Bentham Addenbrookes Hospital NHS Foundation Trust
  • Kayvan Khadjooi Addenbrookes Hospital NHS Foundation Trust
  • Nikhil Sharma The National Hospital of Neurology and Neurosurgery, London, UK.
DOI: https://doi.org/10.12890/2015_000295

Keywords

Stroke, carotid, carotid artery dissection, CT perfusion, stenting, endovascular

Abstract

Carotid artery dissection (CAD) is a major cause of stroke in those under age 45, accounting for around 20% of ischaemic events[1,2]. In the absence of known connective tissue disorders, most dissections are traumatic[2]. First-line management is comprised of antiplatelet or anticoagulation therapy, but many traumatic dissections progress despite this and carry the risk of long-term complications from embolism or stenosis[3].
We report a case of traumatic bilateral carotid dissection leading to progressive neurological symptoms and hypoperfusion on computed tomography perfusion (CTP), despite escalation in anticoagulation, which led to emergency carotid stenting.

Author Biographies

Kayvan Khadjooi ,
Addenbrookes Hospital NHS Foundation Trust Consultant in Stroke Medicine

Nikhil Sharma ,
The National Hospital of Neurology and Neurosurgery, London, UK.

Consultant Neurologist and Senior Clinical Researcher

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References

  • Leys D, Bandu L, Hénon H, Lucas C, Mounier-Vehier F, Rondepierre P, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 2002;59:26–33.
  • Redekop GJ. Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci 2008;35:146–152.
  • Menon R, Kerry S, Norris JW, Markus HS. Treatment of cervical artery dissection: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2008;79:1122–7.
  • Engelter ST, Brandt T, Debette S, Caso V, Lichy C, Pezzini A, et al. Antiplatelets versus anticoagulation in cervical artery dissection. Stroke 2007;38:2605–11.
  • Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology 2012;79:686–9.
  • Lichy C, Metso A, Pezzini A, Leys D, Metso T, Lyrer P, et al. Predictors of delayed stroke in patients with cervical artery dissection. Int J Stroke 2012;10:1–4.
  • Droste DW, Junker K, Stögbauer F, Lowens S, Besselmann M, Braun B, et al. Clinically silent circulating microemboli in 20 patients with carotid or vertebral artery dissection. Cerebrovasc Dis 2001;12:181–5.
  • Cohen JE, Ben-Hur T, Rajz G, Umansky F, Gomori JM. Endovascular stent-assisted angioplasty in the management of traumatic internal carotid artery dissections. Stroke 2005;36:e45–7.
  • Xianjun H, Zhiming Z. A systematic review of endovascular management of internal carotid artery dissections. Interv Neurol;1:164–70.
  • Merckel LG, Van der Heijden J, Jongen LM, van Es HW, Prokop M, Waaijer A. Effect of stenting on cerebral CT perfusion in symptomatic and asymptomatic patients with carotid artery stenosis. AJNR Am J Neuroradiol 2012;33:280–5.

    • Published: 2015-12-14

    Issue: Vol. 3 No. 1 (view)

    Section: Articles

    How to cite:
    1.
    Induruwa I, Bentham C, Khadjooi K, Sharma N. Computed Tomography Perfusion Can Guide Endovascular Therapy in Bilateral Carotid Artery Dissection. EJCRIM 2015;3 doi:10.12890/2015_000295.