ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 2003 March;10(1):67-75

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Spontaneous carotid artery dissections. Report of 10 cases

Adorni A., Busi N., Adorni An., Sianesi M.

Istituto di Clinica Chirurgica Generale e dei Trapianti d’Organo Università degli Studi di Parma, Parma

Back­ground. The ­long-­term devel­op­ment of ­carotid dis­sec­tion was eval­u­ated.
­Methods. A ret­ro­spec­tive ­study ­with a ­mean ­follow-up ­period of 5.5 ­months (­range: 1-10 ­months) was con­ducted on 10 ­patients (8 men, 2 ­women; ­mean age: 50 ­years) ­admitted on emer­gency and ­treated at our ­unit for ­acute neu­ro­log­ical symp­toms. Diag­nosis of spon­ta­neous extra­cra­nial ­carotid ­artery dis­sec­tion was ­based on evi­dence ­from ­echo ­color-Dop­pler sonog­raphy and angio­graphy ­studies of the ­supra-aortic ­trunks. Med­ical treat­ment was insti­tuted in 9 ­patients (5 ­received ­only anti­platelet ­agents, 2 ­only anti­co­ag­u­lants, 2 com­bined anti­platelet and anti­co­ag­u­lant ­therapy, 1 sur­gical treat­ment). ­During the ­follow-up ­period, regres­sion of neu­ro­log­ical symp­toms and devel­op­ment of the ­lesions ­were ­assessed by flow­meter anal­ysis and angio­graphy.
­Results. By the end of ­follow-up, 1 ­patient ­treated ­with anti­platelet ­therapy ­alone expe­ri­enced neu­ro­log­ical ­sequelae ­despite com­plete vas­cular rec­a­nal­iza­tion ­after 8 ­months; the 1 ­patient who under­went sur­gery devel­oped a com­plete occlu­sion ­after 4 ­months, ­with per­sis­tence of neu­ro­logic def­i­cits. In all the ­other ­patients neu­ro­logic symp­toms ­resolved.
Con­clu­sions. In agree­ment ­with the lit­er­a­ture, the ­data ­from ­this ­small ­case ­series sup­port a non­in­va­sive ­approach to the treat­ment of ­this ­pathology, ­wherein med­ical ­therapy ­should be pro­longed and ­patients fol­lowed up ­closely.