Abstract
Objective: We report a case in which acute carotid stenting was performed for spontaneous dissection of the internal carotid artery (IC).
Case: A 66-year-old male developed sudden amaurosis fugax and right hemiparesis and came to us. Cerebral angiography revealed irregularities of the carotid wall, stasis of the contrast agent, and delayed cerebral blood flow from the cervical carotid bifurcation to the C5 portion of the IC. Based on these observations, IC dissection was diagnosed. After hospitalization, we initiated bed rest and medical therapy. Two days after onset, increased infarcts on MRI and a decrease of hemispheric blood flow on SPECT due to possible embolization secondary to thrombus formation were observed. We determined that active treatment was indicated and acute stenting was performed on the same day. Stenting was performed under local anesthesia and distal protection. Implementation of two Driver stents and 1 Wallstent RP improved the IC morphology and cerebral blood flow. Although sensory disturbance remained in the right lower limb, the patient was ambulatory and was discharged on Day 11.
Conclusion: Minimally invasive percutaneous carotid stenting is a useful alternative for cases presenting with spontaneous IC dissection that exhibit resistance to medical therapy.
