Spontaneous bilateral internal carotid and vertebral artery dissections with dominant-hemisphere circulation maintained by external carotid artery–ophthalmic artery anastomoses

Abstract

<jats:p>Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections. Collateral response involved extensive external carotid artery–internal carotid artery anastomoses via the ophthalmic artery, which were instrumental in maintaining perfusion because circle of Willis and leptomeningeal anastomotic responses were hampered by the dissection burden in the corresponding collateral vessels. Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.</jats:p>

Vertebrobasilar and internal carotid arteries dissection in 188 patients

“…Four-vessel involvement, e.g. both ICAs and VAs, was registered by us in a subsequent patient (in preparation), and by others in 0.1-0.5% [5,23,25,26,28,30,31,35,[37][38][39][40].…”

Urgent Carotid Artery Stenting with Intracranial and Carotid Stent for Symptomatic Bilateral Consecutive Internal Carotid Artery Dissection: A Case Report

“…Previously used intracranial compatible stents for CAD include coronary stents, atherosclerotic stents, aneurysm neck-bridge stents, and flow-diverter stents. 18 , 19 ) Coronary stents are balloon-expandable stents that are relatively inflexible and difficult to guide in the petrous portion. Additionally, balloon-expandable stents are inherently noncompliant and can exert traumatic radial force during deployment in dissected vessels, leading to further dissection.…”

“…Braided stents are substantially more thrombogenic than other types of stents in emergency cases where antiplatelet function is difficult to assess. 19 ) Flow-diverter stents are also braided stents and are associated with risks in emergency cases. In our case, we used a self-expanding, laser-cut stent with an open-cell design (Neuroform/Neuroform Atlas, Stryker) for residual CAD in the petrous portion of the ICA.…”