2022 Volume 7 Issue 2 Pages 75-83
Objective: Cervical internal carotid artery dissection is rare in Japan. We described a case of intracranial large vessel occlusion from cervical internal carotid artery dissection, and discussed the effectiveness and problems of endovascular surgery.
Case Presentation: A 74-year-old male presented with right hemiparesis and motor aphasia. Magnetic resonance (MR) imaging showed slightly ischemic lesions at the left cerebral hemisphere. MR angiography showed a left internal carotid artery occlusion. Intravenous tissue plasminogen activator was then infused. We diagnosed an intracranial large vessel occlusion and cervical internal carotid artery dissection based on angiography of the pseudo-lumen complicated with the arterial tortuosity and thrombus, and performed mechanical thrombectomy with a stent retriever and carotid artery stenting, which recanalized the intracranial vessels and dilated the dissected cervical internal carotid artery. The residual thrombus and dissected wall at the tortuous artery partially interrupted the cerebral blood flow. Contrast computed tomography at the chronic phase indicated the stable residual dissected, which did not interrupt the cerebral blood flow.
Conclusion: Endovascular surgery is effective for intracranial large vessel occlusions due to cervical internal carotid artery dissection. We should select adequate devices and carefully perform the surgery, as an associated arterial tortuosity and thrombus may be risk factors for the procedural complication.
