The Clinical Feature And The Treatment Of Spontaneous Dissection Of The Internal Carotid Artery

Carotid artery dissection is a major cause of cerebral ischaemia in youngadults.The pathogenesis of sICAD is incompletely understood. sICAD has beenreported in associations with weak trauma, genetic factors, infections, migraine,smoking, hypertension and contraceptive use.The clinical manifestations ofCAD are neck pain and headache, partial Horner’s syndrome,ipsilateral cranialnerve palsies, ipsilateral cerebral or retinal ischemia, Transient Ischemic Attackor stroke.Severe cases can be disabling or even life-threatening.sICAD havelow incidence and rare clinical and is easy to be made misdiagnosed andmissed.This study aims to study the clinical feature and the treatment ofspontaneous dissection of the internal carotid artery.In January2008to April2011in our clinic or hospital ward8cases ofspontaneous dissection of the internal carotid artery with the method of digitalsubstraction angiography.The data about the clinical features, imaginefeatures(Color-coded ultrasound Doppler of the internal carotid arteryMRI/MRA CT/CTA DSA),treatment and outcomes of8ischemic strokepatients obtained from restrospective stroke registry of our hospital werereviewed and analyzed.As shown in the results:(1) All patients are younger, average age49years,acute or subacute onset.(2) Clinical presentations included8cases transientischemic attack stroke or TIA,7cases neck or head pain(87.5%),2caseHorner’s syndrome(25.0%),3cases amaurosis fugax(37.5%).(3) CT/MRIshowed cerebral infarction-like. Imgage for Unilateral or Bilateral of segmentinternal carotid artery is the C1to(or) C4.The respective1case CTA and ColorDoppler showing double lumen;3cases MRI/MRA showing a mural haematoma and a semilunar hyperintense signal;All cases digital subtractionangiography appearanced rat tail signstring sign or double lumen.(4)Allpatients accepted anti-plateletaggregation treatment and5patients acceptedcarotid angioplasty and stenting.The Followingup data after6months to1yearshowed all the patient got improvement of neurological function.Base on the results above,we summarized such conclusions asfollowing:(1)Age of onset in patients with carotid artery dissection light, themain clinical manifestations of ischemie;(2)Carotid artery dissection in patientswith vascular disease mainly to the neek,head of vascular test results werenegative.Diagnosis of sICAD may depend on clinical manifestations combinedwith characteristic signs in cranial MRI,Color Doppler Imaging of CarotidArteries and DSA were vital clues for making diagnosis.(3)Endovascularstent-assisted repair of sICAD was safe and effective in this experience and canbe recommended for selected patients.