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

Abstract

Objective: We report two patients with cerebral infarction who underwent endovascular treatment for internal carotid artery dissection related to an elongated styloid process.

Case Presentations: Case 1: A 48-year-old male. Paralysis of the left upper/lower limbs occurred. On arrival, the National Institute of Health Stroke Scale (NIHSS) score was 14. MRI revealed acute-stage infarction, narrowing of the high-level internal carotid artery adjacent to the right styloid process, and occlusion of the right middle cerebral artery (MCA). After internal carotid artery stenting (CAS), mechanical thrombectomy for distal embolism was performed, leading to recanalization. Case 2: A 45-year-old male. Aphasia and paralysis of the right upper/lower limbs occurred. On arrival, the NIHSS score was 8. MRI showed acute-stage infarction and narrowing of the high-level internal carotid artery adjacent to the left styloid process. Conservative treatment was administered. As there was a dissecting aneurysmal change at the stenotic site, carotid-stent-assisted coil embolization was performed. In the two patients, endovascular treatment led to a favorable prognosis.

Conclusion: For the treatment of arteriogenic cerebral infarction related to atypical stenosis of the high-level cervical internal carotid artery, it is important to review therapeutic strategies, considering the possibility of an elongated styloid process.