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International Angiology 1998 June;17(2):125-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment of spontaneous internal carotid dissection

Balas P., Ioannou N., Milas Ph., Klonaris Ch.

From the HYGEIA Hospital, *Professor of Surgery Emeritus Athens University Medical School, Athens, Greece


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Spontaneous dis­sec­tion of the inter­nal carot­id ­artery is rare­ly sub­mit­ted to sur­gery. We ­report a case suc­cess­ful­ly oper­at­ed on with com­plete res­to­ra­tion of the cere­bral blood flow. A 43-year-old male was admit­ted to our hos­pi­tal 10 days after an epi­sode of amau­ro­sis fugax of the left eye, left sided head­ache and pare­sis of the right arm of a few hours dura­tion. A diag­no­sis of dis­sec­tion of the left inter­nal carot­id ­artery was made by ­duplex and trip­lex ultra­sound exam­ina­tion and was con­firmed by cere­bral arter­i­og­ra­phy in con­trast to mag­net­ic res­o­nance angio­gra­phy which was mis­lead­ing. Due to the slow arte­ri­al flow from the right to the left cere­bral hem­i­sphere ­through only the pos­te­ri­or com­mu­ni­cat­ing arter­ies we envis­aged the pos­sibil­ity of a cere­bral infarc­tion if the dis­sec­tion were to be extend­ed. For this rea­son a sur­gi­cal pro­ce­dure was per­formed by excis­ing the dis­sect­ed seg­ment and insert­ing a ­venous graft for the re-estab­lish­ment of the arte­ri­al flow. Surgical treat­ment of spon­ta­ne­ous inter­nal carot­id dis­sec­tion ­should be con­sid­ered very care­ful­ly when the clin­i­cal and labor­a­to­ry find­ings sug­gest the pos­sibil­ity of an impend­ing ­stroke.

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