27. Intervention for internal carotid artery dissection under intravascular ultrasound guidance
Main Article Content
Abstract
Spontaneous internal carotid artery (ICA) dissection is a rare but significant cause of ischemic stroke, particularly in patients under 60 years old. Early diagnosis and treatment play a crucial role in preventing serious neurological complications. Intravascular ultrasound (IVUS) is a valuable tool for accurately assessing lesions, guiding stent placement, and optimizing procedural outcomes in coronary interventions. However, in carotid interventions, no dedicated IVUS system has yet been specifically designed for imaging the carotid intima. We report the case of a 73-years-old male patient with spontaneous dissection of the proximal segment of the left ICA, diagnosed by vascular imaging and successfully treated with carotid artery stenting (CAS) under IVUS guidance. This modality enabled precise characterization of the lesion, facilitated optimal stent deployment, and provided post-intervention assessment. Achievement of effective revascularization would prevent recurrent stroke.
Article Details
Keywords
Internal Carotid Artery Dissection, Transient Ischemic Attack, Intravascular Ultrasound, Magnetic Resonance Imaging, CT Angiography
References
2. Giroud M, Fayolle H, André N, et al. Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiatry. 1994; 57(11): 1443.
3. Kwon JY, Kim NY, Suh DC, Kang DW, Kwon SU, Kim JS. Intracranial and extracranial arterial dissection presenting with ischemic stroke: Lesion location and stroke mechanism. Journal of the Neurological Sciences. 2015; 358(1-2): 371-376. doi:10.1016/j.jns.2015.09.368.
4. Malek AM, Higashida RT, Phatouros CC, et al. Endovascular Management of Extracranial Carotid Artery Dissection Achieved Using Stent Angioplasty. AJNR Am J Neuroradiol. 2000; 21(7): 1280-1292.
5. Zacharatos H, Hassan AE, Qureshi AI. Intravascular Ultrasound: Principles and Cerebrovascular Applications. American Journal of Neuroradiology. 2010; 31(4): 586-597. doi:10.3174/ajnr.A1810.
6. Debette S, Mazighi M, Bijlenga P, et al. ESO guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal. 2021; 6(3): XXXIX-LXXXVIII. doi:10.1177/23969873211046475.
7. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2014; 45(7): 2160-2236. doi:10.1161/STR.0000000000000024.
8. Clark DJ, Lessio S, O’Donoghue M, Schainfeld R, Rosenfield K. Safety and utility of intravascular ultrasound-guided carotid artery stenting. Cathet Cardio Intervent. 2004; 63(3): 355-362. doi:10.1002/ccd.20188.
9. Fu PC, Wang JY, Su Y, et al. Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports. World J Clin Cases. 2023; 11(29): 7127-7135. doi:10.12998/wjcc.v11.i29.7127.
10. Sanada T, Wada H, Sato H, Shirai W, Kinoshita M, Tokumitsu N. Carotid artery stenting assisted with intravascular ultrasonography for isolated spontaneous common carotid artery dissection. J Surg Case Rep. 2021; 2021(6): rjab232. doi:10.1093/jscr/rjab232.
11. Ikeuchi Y, Shimasaki T, Tachizawa N, Yamamoto Y, Ishii T. Successful intravascular ultrasonography-assisted carotid artery stenting for iatrogenic carotid artery dissection: Illustrative case. Interdisciplinary Neurosurgery. 2022; 28: 101527. doi:10.1016/j.inat.2022.101527.