Traumatic cervical carotid artery dissection that movable dissecting flap intermittently obstructed the internal carotid artery and caused repeated transient ischemic attack: a case report

Abstract

We report a rare case of traumatic carotid artery dissection that movable dissecting flap intermittently obstructed the internal carotid artery and caused the repeated transient ischemic attack. A 66-year-old female with transient motor weakness of her right hand continues from 30 seconds to 1 minute attend to our hospital. Cervical MR angiography revealed left internal carotid artery stenosis. MRI denied new ischemic lesion in the cerebrum. Her symptom was considered as transient ischemic attack related to her cervical artery stenosis. Catheter angiography revealed left internal carotid artery dissection, and medical interview disclosed her the history of manual strike 1 month before admission. CT and MRI revealed no evidence of obvious thrombus in the false lumen of the dissection. Cerebral blood flow images with SPECT showed no hypoperfusion and cerebrovascular reserve in her cerebral hemisphere. The mechanism of her cerebral ischemic attack was unclear. But a decision was made to treat the dissection flap by stent placement. Vascular endoscope during the treatment procedure found out the movable dissection flap and it was suggested blood inflow to the false lumen made intermittently close the flow to true vascular lumen resulted in ischemic attack. Her ischemic attack was completely dissolved after stenting. The pathophysiological mechanisms of repeated ischemic attack and optimal treatment for traumatic carotid artery dissection are discussed.