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      Dissective tandem stroke: an endovascular approach

      case-report

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          Abstract

          Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.

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          Cervical-artery dissections: predisposing factors, diagnosis, and outcome.

          Stephanie Debette, Didier Leys (2009)
          Cervical-artery dissection (CAD) is a major cause of cerebral ischaemia in young adults and can lead to various clinical symptoms, some of which are benign (eg, headache, neck pain, Horner's syndrome, and cranial-nerve palsy), but most patients have a stroke or transient ischaemic attack. In addition to trauma to the neck, other risk factors have been suggested, such as infection, migraine, hyperhomocysteinaemia, and the 677TT genotype of the 5,10-methylenetetrahydrofolate reductase gene (MTHFR 677TT), although evidence is sparse. An underlying arteriopathy, which could in part be genetically determined, is believed to have a role in the development of CAD. Importantly, both research on and optimum management of CAD strongly rely on diagnostic accuracy. Although the functional outcome of CAD is good in most patients, socioprofessional effects can be important. Incidence of the disorder in the general population is underestimated. Mortality and short-term recurrence rates are low but possibly also underestimated. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.
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            Blunt carotid arterial injuries: implications of a new grading scale.

            Sophie E. Moore, K E Brega, Walter L Biffl … (1999)
            Blunt carotid arterial injuries (BCI) have the potential for devastating outcomes. A paucity of literature and the absence of a formal BCI grading scale have been major impediments to the formulation of sound practice guidelines. We reviewed our experience with 109 BCI and developed a grading scale with prognostic and therapeutic implications. Patients admitted to a Level I trauma center were evaluated with cerebral arteriography if they exhibited signs or symptoms of BCI or met criteria for screening. Patients with BCI were treated with heparin unless they had contraindications, and follow-up arteriography was performed at 7 to 10 days. Endovascular stents were deployed selectively. A prospective database was used to track the patients. A total of 76 patients were diagnosed with 109 BCI. Two-thirds of mild intimal injuries (grade I) healed, regardless of therapy. Dissections or hematomas with luminal stenosis (grade II) progressed, despite heparin therapy in 70% of cases. Only 8% of pseudoaneurysms (grade III) healed with heparin, but 89% resolved after endovascular stent placement. Occlusions (grade IV) did not recanalize in the early postinjury period. Grade V injuries (transections) were lethal and refractory to intervention. Stroke risk increased with injury grade. Severe head injuries (Glasgow Coma Scale score < or =6) were found in 46% of patients and confounded evaluation of neurologic outcomes. This BCI grading scale has prognostic and therapeutic implications. Nonoperative treatment options for grade I BCI should be evaluated in prospective, randomized trials. Accessible grade II, III, IV, and V lesions should be surgically repaired. Inaccessible grade II, III, and IV injuries should be treated with systemic anticoagulation. Endovascular techniques may be the only recourse in high grade V injuries and warrant controlled evaluation in the treatment of grade III BCI.
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              Incidence and outcome of cervical artery dissection: a population-based study.

              Gordon Brown, Adrian V. Lee, Bahram Mokri … (2006)
              Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available. To determine the incidence rate of cervical artery dissection (CAD) in a defined population. With IRB approval, we used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987-2003 in Olmsted County, MN. Of 48 patients with CAD, there were 32 patients with ICAD and 18 patients with VAD. In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% CI, 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of dissection was observed during a mean 7.8 years of follow-up. Internal carotid artery dissection was detected approximately twice as frequently as vertebral artery dissection in the overall study, but in the latter half of the study period, vertebral artery and internal carotid artery dissection incidence rates were equivalent. The majority of cervical artery dissection patients in the community have excellent outcome, and contrary to many tertiary referral series, re-dissection is rare.
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                Author and article information

                Contributors
                Amedeo Guida
                Journal
                Journal ID (nlm-ta): Radiol Case Rep
                Journal ID (iso-abbrev): Radiol Case Rep
                Title: Radiology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 1930-0433
                Publication date PMC-release: 15 April 2022
                Publication date Collection: June 2022
                Publication date (Electronic): 15 April 2022
                Volume: 17
                Issue: 6
                Pages: 2170-2174
                Affiliations
                [a ]Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
                [b ]Department of Neuroscience and Reproductive Sciences and Dentistry, University “Federico II”, Naples, Italy
                Author notes
                [* ]Corresponding author. amedeoguida@ 123456gmail.com
                [#]

                These authors equally contributed to the paper

                Article
                Publisher Item ID: S1930-0433(22)00263-1
                DOI: 10.1016/j.radcr.2022.03.086
                PMC ID: 9035657
                PubMed ID: 35479967
                SO-VID: a9aa11fe-2fb0-47a9-b5bf-1f3bf0049756
                Copyright © © 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 16 March 2022
                Date revision received : 21 March 2022
                Date accepted : 23 March 2022
                Categories
                Subject: Case Report

                Data availability:

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