Endovascular management of internal carotid artery dissection with associated aneurysm using a multilayer flow modulator

Abstract

Extracranial carotid artery dissection represents up to 22% of acute neurovascular disease in young patients. There are no specific guidelines regarding indication for endovascular management of carotid artery dissection with stenting and its complications. We describe three patients with carotid artery dissection and associated dissecting aneurysm who underwent endovascular stenting with the multilayer flow modulator. At 12-month follow-up, the dissecting aneurysms were resolved, and positive clinical outcome was achieved in all patients. Our results suggest that the multilayer flow modulator may be an alternative option for endovascular interventions in patients with carotid artery dissection and pseudoaneurysms because it favors laminar flow, and it may promote spontaneous healing of the wall by progressively reducing the vascular stress in the aneurysm wall. However, further studies are needed to confirm these findings.

Hypoglossal Nerve Neuropathies—Analysis of Causes and Anatomical Background

“…The annual incidence in the general population varies from between 2.5 and 3 persons per 100,000 [45]. The pseudoaneurysm is a serious complication of the injury to the arterial walls and in 12% to 17% of patients, it occurs within five years after the initial damage [46,47]. The damage to the nerve develops in two basic ways: direct compression or ischemia secondary to ligation or avulsion of the vasa nervorum [48].…”

“…The first symptoms that may indicate spontaneous infraclinoidal dissection of ICA include unilateral temporal headache, neck pain, bruises, visual symptoms, and cerebral deficits. The presence of oculosympathetic impairment in the form of partial Horner's syndrome might be the result of damage to the sympathetic fibers looping around the ICA [41,47]. Horner's syndrome may concern about 20% of patients with ICA dissection [61].…”

“…Horner's syndrome may concern about 20% of patients with ICA dissection [61]. Due to the abundance of nerve plexuses supporting the vessels, the pain may be located distantly from the actual lesion, although it is mainly caused by the tearing of the vessel [41,47].…”