抄録
We report two cases of cervical carotid artery dissection that presented neurological deterioration due to middle cerebral artery embolism under anti-thrombosis therapy. Case 1: a 58-year-old man was admitted to our hospital with right ophthalmic pain and minor stroke (NIHSS=2/42). While he was initially treated with anti-platelet and anti-coagulation therapy, he suddenly developed left hemiplegia and disturbed consciousness (NIHSS=25/42) due to tandem occlusion of the middle cerebral artery and the internal carotid artery. The patient was treated by endovascular stent-assisted thrombolysis with subsequent dramatic improvement. The self-expandable stent that was deployed in the dissected carotid artery expanded to maximum size. Case 2: a 59-year-old man was administered anti-platelet therapy for minor stroke (NIHSS=1/42) due to cervical artery dissection. After one week, he developed motor aphasia and right hemiparesis (NIHSS=8/42). Because a recanalization of middle cerebral artery happened immediately, anti-coagulation therapy was added without interventional therapy. The patient showed good recovery (mRS=1), and the carotid artery dissection was revealed to be restored with complete recanalization after three weeks.
Anti-coagulation or anti-platelet therapy has been recommended in the case of carotid artery dissection. It is unclear whether stent-deployment of cervical artery dissection for endovascular thrombolysis is the best treatment or not.
