Carotid artery stenting assisted with intravascular ultrasonography for isolated spontaneous common carotid artery dissection

Abstract

Isolated spontaneous common carotid artery (CCA) dissection is extremely rare. Moreover, only a few case reports for isolated spontaneous CCA dissection treated with carotid artery stenting (CAS) can be found so far. Here, the authors report a case where intravascular ultrasonography (IVUS) provided valuable information about lesion evaluation, stent selection and stent placement during CAS for isolated CCA dissection. A 69-year-old male was diagnosed with an isolated spontaneous left CCA dissection. CAS assisted with IVUS was performed to prevent further dissection and cerebral infarction recurrence. To the best of our knowledge, this is the first case report of an isolated spontaneous CCA dissection treated with CAS assisted by IVUS. CAS assisted by IVUS may be an effective treatment option to prevent intraoperative complications and further stroke recurrence for isolated spontaneous CCA dissection.

Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports

“…IVUS has unique advantages for the treatment of aortic dissection. IVUS-assisted CAS may be an effective treatment option to prevent intraoperative complications and further stroke recurrence for isolated spontaneous CCA dissection[ 19 ]. IVUS compensates for the insufficiency in the assessment of atherosclerotic plaque composition and intravascular arterial morphology, which are difficult to evaluate using DSA[ 9 ].…”

A Rare Case of Isolated Spontaneous Common Carotid Artery Dissection Treated by Telescoping Stents

“…Moreover, it could be difficult to differentiate an irregular atherosclerotic plaque in the CCA from a dissection just by evaluating an angiographical morphology. A carotid ultrasonography can be useful in detecting the intimal flap, confirming the range of dissection, and differentiating from a calcified plaque [4]. The clinical course should be monitored carefully with detailed inspections of imaging for suspicious lesions because a spontaneous CCA dissection often leads to unstable stenosis causing recurrent embolism.…”

“…Although there are no clear evidence-based guidelines for the treatment of the spontaneous CCA dissection, strategies for the treatment of the cervical ICA dissection could be similarly adopted [6,12,13]. The treatment goal should be the maintenance of adequate distal flow for cerebral perfusion, the prevention of further distal embolism, and the prevention of progression of stenosis [4]. An emergent endovascular recanalization may be required for a serious case with a concomitant intracranial large vessel occlusion if the patient meets the adequate indication at an early time window.…”

“…If the dissection is unstable, causing recurrent embolic or hemodynamic infarctions as in this case study, a carotid stenting is required to stabilize the lesion unless prompt and full responses to the medication is evidenced. Since only a few case reports for isolated spontaneous CCA dissection treated with a carotid stent can be found in the literature so far, further large-scale studies with long-term follow-up data are required to elucidate its feasibility and durability [4]. According to reports on CCA and ICA dissection caused by different etiologies, multiple stents were frequently required due to the long length of the dissection [4,7,8,12,13].…”

“…Spontaneous carotid dissection can be an important cause of stroke usually in the young population, and it is encountered usually in the cervical segment of the internal carotid artery (ICA). Spontaneous dissection of the common carotid artery (CCA) is an extremely rare cause of ischemic stroke [1][2][3][4][5][6]. Most CCA dissections are caused by an extension of an aortic dissection, and direct traumas and iatrogenic etiologies, such as vascular procedures, are known to be relatively less common causes [1,[7][8][9][10][11].…”