Two Patients with Cerebral Infarction Who Underwent Endovascular Treatment for Internal Carotid Artery Dissection Related to an Elongated Styloid Process

Shimozato, Rin; Hayashi, Mototaka; Niimura, Manabu; Kugasawa, Kazuha; Uemura, Hiroya; Hidaka, Yukihiro; Takezawa, Hidesato; Hamanaka, Masashi; Imai, Keisuke; Iijima, Akira

doi:10.5797/jnet.cr.2017-0102

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Of the above 20 patients with cerebral ischemia, endovascular thrombectomy was performed as initial treatment in six patients. 3,9,10,13,16,17) In three of the six patients, the presence of an elongated styloid process was clear in the initial phase of treatment. In these patients, CTA had been conducted on admission.…”

Section: Discussionmentioning

confidence: 90%

“…3) To our knowledge, 20 patients with dissection of the ICA who initially developed cerebral ischemia, such as transient ischemic attacks (TIAs) and cerebral infarction, due to Eagle syndrome have been reported ( Table 1). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] ICA dissection associated with an elongated styloid process is rare, but the number of case reports has recently increased; the involvement of an elongated styloid process in idiopathic cervical ICA dissection may be more frequent than previously recognized.…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies indicated that cervical internal carotid artery (ICA) dissection related to mechanical compression of this artery occurred, 2) inducing transient cerebral ischemic attacks or cerebral infarction. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In this study, we report a patient with cerebral infarction and acute occlusion of the ICA in whom recanalization was achieved by combining thrombectomy with carotid artery stenting (CAS), but stent fracture and aneurysm formation at the site of fracture were observed after 3 months, and stent-assisted coil embolization was performed as additional treatment, and review the literature.…”

Section: Introductionmentioning

confidence: 99%

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Carotid Stent Fracture due to Eagle Syndrome after Endovascular Stenting for the Treatment of Acute Ischemic Stroke Caused by Internal Carotid Artery Dissection: Case Report

Yano

Sasaki

Kiyohara

et al. 2019

NOUSHINKEI KEKKANNAI TIRYOU

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Objective:We report a case of stent fracture caused by an elongated styloid process, a form of Eagle syndrome.Case Presentation: A 58-year-old man presented with sudden right hemisensation disturbance and aphasia. MRI revealed multiple acute cerebral infarction in the left parietal and insula cortex. MRA revealed a left-sided internal carotid artery (ICA) occlusion distal to the carotid bifurcation. Digital subtraction angiography (DSA) revealed a left-sided ICA dissection distal to the carotid bifurcation. We performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis in cerebral infarction (TICI) grade III was achieved. We performed DSA 3 months after an operation, it showed stent fracture and aneurysmal formation in the stent fractured department. From CT findings, the carotid artery dissection and stent fracture appeared to be triggered by the elongated styloid process. We performed stent-assisted coil embolization. After conducting percutaneous transluminal angioplasty (PTA) at high pressure after coil embolization, the elongated styloid process was fractured, and accepted a shift to the outside of the stent contact department. The patient was discharged without medical problems, and no recurrence was observed for 2 months after the surgery. Conclusion:We experienced a rare case of ICA dissection and carotid stent fracture from Eagle syndrome. Eagle syndrome is an important disease to consider in the differential diagnosis of extracranial carotid artery dissection.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Carotid Stent Fracture due to Eagle Syndrome after Endovascular Stenting for the Treatment of Acute Ischemic Stroke Caused by Internal Carotid Artery Dissection: Case Report

Yano

Sasaki

Kiyohara

et al. 2019

NOUSHINKEI KEKKANNAI TIRYOU

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“…e demographic, clinical characteristics, treatment strategies, and follow-up of the patients are summarized in Table 1. [1,2,5,6,10,[14][15][16][18][19][20][21]23,24,27,30,31,37,38,[42][43][44][45][46][47][50][51][52]54,55,57] e mean age of the patients was 48.2 years (range 30-72). In an article, one patient was described as a "teenager" but was not used for statistical evaluation.…”

Section: Resultsmentioning

confidence: 99%

Eagle syndrome: An updated review

Pagano,

Ricciuti,

Mancini

et al. 2023

Surgical Neurology International

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Background: This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible therapeutic strategies. Methods: We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords “vascular AND Eagle syndrome,” “vascular AND styloid syndrome,” “vascular AND elongated styloid process,” “vascular AND stylocarotid syndrome,” and “Eagle syndrome AND carotid artery dissection.” Results: 38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (n 21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed. Conclusion: ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.

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“…8 Late complications can occur in patients without ESP resection, namely recurrent stroke, carotid stent fracture, persistent ICA stenosis with dissection flap, stent displacement and pseudoaneurysm formation, so stylectomy or delayed imaging should be considered. [9][10][11][12]…”

Section: Descriptionmentioning

confidence: 99%