Literature Review and Report of Five Cases of Spontaneous Carotid Artery Dissection

Abstract

Spontaneous cervical arterial dissection (SCAD) is a non-traumatic tear or disruption in the walls of the internal carotid arteries. SCAD is the leading cause of stroke in patients <45 years of age, accounting for almost one-fourth of strokes in this population. However, standard criteria for its treatment have not been established. Therefore, we reviewed five cases of SCAD (four men, one woman; mean age 47.0 ± 12.7 years) treated between November 2009 and January 2013 to determine the appropriate treatment. Three patients had cerebral infarctions; of them, two underwent revascularization surgery. One was treated with superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) and ligation of the cervical internal carotid artery. The other was treated with radial artery grafted external carotid artery-MCA bypass and ligation of the cervical internal carotid artery. The other three patients were treated with conservative therapy, which included an antithrombotic agent in two. Only one patient was not treated with an antithrombotic agent because he had no cerebral ischemia. Of all patients, only one, who was treated with STA-MCA bypass and ligation of the cervical internal carotid artery, progressed to cerebral ischemia. SCAD is reversible in most cases. Therefore, conservative therapy is recommended, except in cases of progressing hemodynamic ischemia and requirement of revascularization because there is no time for recovery.