Abstract
Dissection of extracranial and intracranial arteries is now recognized as an important cause of stroke and transient cerebral ischemia. Causes of dissection can be spontaneous, traumatic, associated with amphetamine abuse, hypertension, fibromuscular dysplasia, and collagen vascular disorders. Dissections can also be caused by iatrogenic injuries during diagnostic and endovascular procedures from injury to the intima and media during guidewire and catheter manipulation within intravascular blood vessels.
We report three cases in which acute dissection of the high cervical internal carotid arteries was iatrogenically induced from guiding catheters causing subintimal dissection and near complete occlusion. Treatment by use of balloon angioplasty techniques and guidewire manipulation across the dissection sites were successful in opening up the injury site to complete patency. Long term follow-up demonstrated continued wide patency without evidence of restenosis or severe intimal irregularity.
As more aggressive therapy by endovascular techniques are utilized for definitive management of intracranial aneurysms, malformations, tumors, and preoperative therapy, the incidence of iatrogenic injuries will increase. Balloon angioplasty techniques to treat acute vessel dissections may be a useful therapy to restore patency of the blood vessel for these patients in selected cases.
