Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases.
(9/120)
Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed. (+info)
Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype in young adults with spontaneous cervical artery dissection and atherothrombotic stroke.
(10/120)
BACKGROUND AND PURPOSE: The role of mild hyperhomocysteinemia as a risk factor for cerebral ischemia may depend on stroke subtype. To test this hypothesis, we undertook a prospective case-control study of a group of patients with spontaneous cervical artery dissection (sCAD), a group of patients with atherothrombotic stroke (non-CAD), and a group of control subjects. METHODS: Fasting total plasma homocysteine (tHcy) concentration, C677T MTHFR genotype, and 844ins68bp CBS genotype were determined in 25 patients with sCAD, 31 patients <45 years of age with non-CAD ischemic stroke, and 36 control subjects. Biochemical data in the patient groups were obtained within the first 72 hours of stroke onset. RESULTS: Median tHcy levels were significantly higher in patients with sCAD (13.2 micromol/L; range, 7 to 32.8 micromol/L) compared with control subjects (8.9 micromol/L; range, 5 to 17.3 micromol/L; 95% CI, 1.05 to 1.52; P=0.006). Cases with tHcy concentration above the cutoff level of 12 micromol/L were significantly more represented in the group of patients with sCAD compared with control subjects (64% versus 13.9%; 95% CI, 2.25 to 44.23; P=0.003); a significant association between the MTHFR TT genotype and sCAD was also observed (36% versus 11.1%; 95% CI, 1.10 to 19.23; P=0.045). No significant difference in tHcy levels and in the prevalence of thermolabile MTHFR was found between patients with non-CAD ischemic stroke and control subjects and between patients with sCAD and non-CAD ischemic stroke. The distribution of the 844ins68bp CBS genotype and the prevalence of subjects carrying both the TT MTHFR and 844ins68bp CBS genotypes were not significantly different among the 3 groups. CONCLUSIONS: Our results are consistent with the hypothesis that increased plasma homocysteine levels and the TT MTHFR genotype may represent risk factors for sCAD. In contrast, their role in atherothrombotic strokes remains a contentious issue. (+info)
Duplex scan findings in patients with spontaneous cervical artery dissections.
(11/120)
AIM: to report duplex scan findings in patients with spontaneous internal carotid artery (ICA) or vertebral artery (VA) dissection. MATERIAL AND METHODS: the records of 24 patients (13 males and 11 females, median age 48 years [range 25-68 years]) with spontaneous extracranial ICA dissection (n=20) or VA dissection (n=4), identified between January 1995 and December 1999, were retrospectively analysed. RESULTS: four different abnormal flow patterns were observed in patients with ICA dissection: (a) absence of flow (15%), (b) staccato flow (50%), (c) reduced flow velocity (25%) and, (d) stenotic flow (10%). B-mode ultrasound showed a homogenous echolucent lesion in eight patients and a double lumen in two. Staccato flow along the entire ICA was observed in only four patients without verified dissection during the study period. In the four patients with VA dissection, duplex scanning demonstrated staccato flow in three and reversed low-amplitude pulsatile flow in one. CONCLUSION: duplex scanning is an important noninvasive diagnostic modality in patients with cervical artery dissection. Staccato flow along the extracranial ICA strongly indicates the presence of spontaneous ICA dissection. (+info)
Ruptured dissecting aneurysm of the vertebral artery associated with occlusive internal carotid artery dissection--case report.
(12/120)
A 64-year-old male presented with subarachnoid hemorrhage. Angiography showed a dissecting aneurysm of the right vertebral artery (VA), and severe stenosis of the right internal carotid artery (ICA). He was treated conservatively in the early stage. Repeat angiography showed enlargement of the dissecting aneurysm of the VA and partial resolution of the stenosis of the right ICA. Intraaneurysmal coil embolization with proximal coil occlusion was performed following a balloon occlusion test. The postoperative course was uneventful. Based on the neuroradiological findings, the stenotic lesion of the right ICA was considered to be due to dissection. Analysis of serial changes in dissecting lesions in the craniocervical arteries is important for the correct choice of treatment, especially in patients with multi-vessel dissections. The surgical options should be determined on an individual basis. (+info)
Carotid artery dissection as a possible severe complication of pertussis in an adult: clinical case report and review.
(13/120)
Adults can experience typical symptoms of pertussis. Complications due to severe paroxysmal coughing have been reported in this age group. We report carotid artery dissection as a possible severe complication of pertussis in a previously healthy adult. Adult booster immunization against pertussis should be considered to protect adults themselves from this illness and its potential complications. (+info)
Infection and the risk of spontaneous cervical artery dissection: a case-control study.
(14/120)
BACKGROUND AND PURPOSE: Several constitutional and environmental risk factors may be involved in the occurrence of spontaneous cervical artery dissection (SCAD). This work explored the association between recent infection and SCAD in an hospital-based case-control study. METHODS: Forty-seven patients with SCAD and 52 with ischemic stroke from another cause were prospectively and consecutively recruited by 2 neurology departments. A specially designed questionnaire was used to assess the history of an acute infection that could have occurred within a month before the vascular event. RESULTS: Acute infection was more frequent in patients with SCAD (31.9%) than in control subjects (13.5%) (crude odds ratio, 3.0; 95% confidence interval, 1.1 to 8.2; P=0.032). This association was stronger in patients with multiple (odds ratio, 6.4) than single artery (odds ratio, 2.1) dissection. CONCLUSIONS: Recent infection is a risk factor and could be a trigger for SCAD. (+info)
We present a case of an 85-year-old woman with a 40-year history of progressive bilateral sensorineural hearing loss. Imaging studies demonstrated bilateral pseudoaneurysms of the petrous portion of the internal carotid arteries eroding into both cochleas. To our knowledge, this is the first case report of such lesions. (+info)
Direct percutaneous puncture of a cervical internal carotid artery aneurysm for coil placement after previous incomplete stent-assisted endovascular treatment.
(16/120)
Direct percutaneous puncture for coil placement has been described for visceral aneurysms, but the procedure has not been previously reported for aneurysms of the head and neck. We report a case in which stent-assisted endovascular treatment was successfully combined with direct puncture for additional coil placement to treat a symptomatic giant aneurysm of the cervical internal carotid artery. (+info)