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ABSTRACTIntroductionWe present a unique case report of a patient who presented to the emergency departmentwith stroke-like symptoms found to have a spontaneous left sided internal carotid arterydissection. Case ReportThe patient was treated successfully with thrombectomy, and subsequently developedcontralateral symptoms caused by a right sided internal carotid artery dissection. This wasmanaged with a second contralateral thrombectomy.  The patient’s course was complicated bypersistent and mild hypotension, postulated to be secondary to bilateral carotid baroreceptortrauma from the dissections. ConclusionThis case highlights the importance of close neurological monitoring for patients,preferably in a neurologic critical care setting, during and after invasive treatments such assystemic thrombolytic administration or mechanical thrombectomy, as identifying the patient’ssubsequent development of contralateral symptoms in a timely fashion was key to his positive outcome.  An additional factor which had a positive impact on this outcome was the use of the RAPID Artificial Intelligence software which assists in determining whether thrombectomy maybe indicated prior to receiving a formal radiologist read on CT angiography/perfusion studies. AI technologies such as this have a great potential to augment and expedite patient care.

Type A aortic dissection (TAAD) is a disease that can have a cataclysmic impact on a patient's life, and early surgical intervention is crucial for survival. Cerebral malperfusion occurs in 6–14% of TAAD patients, primarily from partial or complete blockage of the arch vessels by the dissection flap, and hypoxic brain injury secondary to tamponade or shock and/or brain embolism from thrombosis of the false lumen. Management protocols for concomitant carotid arterial dissection in TAAD patients are inconsistent in the current literature. Through this case report, we have tried to describe our easily replicable strategies to manage bilateral carotid artery involvement in TAAD, avoiding total circulatory arrest (TCA), in a neurologically intact patient with good neurological outcome. [ABSTRACT FROM AUTHOR]

Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Eagle syndrome is defined as a collection of symptoms affecting the cervical and cranial regions, resulting from an elongated styloid process or ossified stylohyoid ligament encroaching on surrounding structures and causing a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. Carotid artery dissection is a rare complication of Eagle syndrome. We report the case of a 40-year-old man who presented with bilateral internal carotid artery dissection secondary to pathological elongation of the styloid processes.

Iatrogenic dissection of the common carotid artery (CCA) is a feared complication of transcarotid artery revascularization (TCAR). However, its management is not well described. We describe our treatment approach to CCA dissection during TCAR in four patients, and discuss risk factors, prophylactic measures, and an algorithmic approach to management.

Ischemic stroke remains today a major health problem that requires adequate management and etiological research. The prevalence in young people has increased.This article is a case report of a 37-year-old female diabetic patient who had an acute ischemic stroke due to spontaneous dissection of the right internal carotid artery.The article discusses the epidemiology, pathophysiology, diagnosis, and treatment of cervical artery dissection, which is a common cause of stroke in young patients. The use of antiplatelet and anticoagulant therapy, as well as endovascular and surgical interventions, is also discussed.Spontaneous carotid bulb dissection is an emergency in ischemic stroke in young people. The prognosis depends on the severity of the initial injury and the extent of collateral circulation, with successful recovery in 75% of cases.

Resumen: Introducción: la disección espontánea de las arterias cervicales representa solo el 2% de todos los ictus, pero supone aproximadamente del 10 al 25% de los ictus en edad juvenil. La etiología de la misma supone en ocasiones un reto diagnóstico. Objetivo: describir un caso de disección carotídea bilateral secuencial con una recurrencia tardía sugerente de arteriopatía subyacente. Pacientes y métodos: una mujer de 54 años con disección carotídea izquierda aguda con lesiones isquémicas agudas/subagudas por embolismo arterio-arterial, que cursaron como accidente isquémico transitorio y síntomas compresivos como expresión clínica mediante síndrome de Horner ipsilateral, que en el estudio mostró una disección carotídea derecha antigua con trombo intraluminal organizado. Interrogada específicamente había presentado cefalea y anisocoria pupilar 8 meses antes, resuelta y por lo que no había consultado. Se realiza un estudio de extensión descrito en el que se pone de manifiesto un síndrome antifosfolípido, tratándose de una confirmación por antecedentes de abortos de repetición. Conclusiones: la disección secuencial con recurrencia tardía parece estar más relacionada con enfermedades subyacentes de tipo arteriopatía o con enfermedades sistémicas como el síndrome antifosfolipídico, por lo que es necesario una amplia detección de enfermedad subyacente. Abstract: Introduction: Spontaneous dissection of cervical arteries represents only 2% of all strokes, but represents approximately 10-25% of strokes in youth. Its etiology is sometimes a diagnostic challenge. Objective: To describe a case of sequential bilateral carotid dissection with a late recurrence suggestive of underlying arteriopathy. Patients and methods: A 54-year-old woman with acute left carotid dissection with acute/subacute ischemic lesions due to arterial-arterial embolism that progressed as a transient ischemic attack and compressive symptoms with clinical expression of ipsilateral Horner syndrome, which in the study showed a previous right carotid dissection with an organized intraluminal thrombus. She had presented headache and pupillary anisocoria 8 months earlier which were solved spontaneusly. A described extension study was carried out in which an antiphospholipid syndrome was revealed, being confirmed by a history of recurrent abortions. Conclusions: Sequential dissection with late recurrence seems to be more related to underlying pathologies likewise arteriopathy or to systemic diseases such as antiphospholipid syndrome, which is why extensive screening for underlying pathology is required.

Stroke continues to be a major public health issue resulting in high mortality and severe long-term disability. Carotid endarterectomy (CEA) plays an important role in the prevention of ischemic stroke. Complications associated with CEA can be life threatening and prompt recognition is crucial. In this report, we present a patient who presented to the hospital with progressive headache, 2 weeks following CEA. He was neurologically intact and hypertensive. Non-contrast head computed tomography (CT) scan showed convexity subarachnoid hemorrhage (SAH). He was found to have a left internal carotid artery dissection. Patients who present to the hospital following CEA with headache and hypertension benefit from a non-contrast head CT scan. The presence of SAH can be a warning sign of cerebral hyperperfusion syndrome. Carotid artery dissection is also a disease entity that can occur in the post-operative period. Prompt recognition and treatment is crucial for the management of these disease entities. [ABSTRACT FROM AUTHOR]

Cervical fractures are rare after non-judicial hangings. Type-III Hangman's fracture (HF) is an unstable injury caused typically by motor vehicle accidents or falls. We describe the first reported case of a Type-III HF combined with occlusion of the right vertebral artery and non-occlusive dissection of both internal carotid arteries caused by near-hanging. We performed a posterior approach open reduction of dislocated C2 facets and C1 to C3 fusion. Carotid dissections were managed conservatively with long-term antiplatelet therapy. The patient survived without any neurological deficit and without any significant restriction of cervical motion. [ABSTRACT FROM AUTHOR]

This case report represents rare complication of carotid surgery, iatrogenic dissection of the common carotid artery and its successful endovascular treatment. We herein report a case of 55 year-old female patient in whom carotid surgery was performed due to constant tinnitus caused by kinking of right internal carotid artery. On day 7th carotid control ultrasound was performed, according to hospital’s protocol. The carotid ultrasound showed dissecting lesion of right common carotid artery in a length of three centimeters that was confirmed with computed tomography angiography of neck vessels, and dual antithrombotic therapy was initiated. One month later percutaneous angioplasty was performed with stent implantation. [ABSTRACT FROM AUTHOR]

Purpose: The role of carotid artery disease (CAD) in the development of various types of ocular arterial occlusive disorders has often been reported. This systematic review aims to evaluate and review the current evidence regarding the role of CAD and the subsequent carotid artery hemodynamic alterations in the development of non-arteritic anterior (NA-AION) and posterior (NA-PION) ischemic optic neuropathy., Methods: We systematically reviewed studies following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We systematically searched PubMed, Embase, and Scopus databases for relevant studies that clearly assessed the role of CAD and the subsequent carotid artery hemodynamic alterations in the development of NA-AION and NA-PION. All studies that examined the associations between CAD and the development of NA-AION and NA-PION in adults aged 18 years or older were synthesized. Quality assessment using the Newcastle-Ottawa Scale (NOS), and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case-Series were also conducted., Results: Our search identified 1933 manuscripts published in the English language. The number of participants with non-arteritic ischemic optic neuropathy (NA-ION) ranged from 1 to 191, with a total of 478 patients experiencing either NA-AION (410 out of 478), NA-PION (13 out of 478), or a combination of thereof (1 out of 478). The number of participants with NA-ION due to atherosclerosis ranged from 1 to 191, with a total of 376 patients., Conclusions: Although carotid artery disease may rarely contribute to the development of NA-ION, it should be considered as a possible cause of NA-ION., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Eagle's syndrome is famous for one of the causes of internal carotid artery dissection. The treatment strategy for the illness, however, is not well established. Here, we report a case of internal carotid dissection due to an elongated styloid process successfully treated by carotid artery stenting (CAS). Case Description: A 72-year-old male with temporary dysarthria and consciousness disorder was diagnosed to suffer from multiple cerebral infarctions due to Eagle's syndrome. A cerebral blood flow (CBF) study revealed decreased blood flow and a CAS was performed 15 days after admission to preserve antegrade blood flow, resulting in full recovery of the affected CBF. Conclusion: We reported a case of vascular Eagle's syndrome in which the patient showed fluctuated neurological deficits successfully treated by CAS. Our experience suggests that cases of vascular Eagle's syndrome due to hemodynamic stress can be treated by CAS. [ABSTRACT FROM AUTHOR]

Resumen: La displasia fibromuscular es una enfermedad no inflamatoria y no aterosclerótica, que puede afectar cualquier lecho arterial; sin embargo, las arterias renales y la carótida interna son las más comprometidas. Se presenta el caso de un paciente que cursó con dolor abdominal y cefalea hemicraneana posterior, con síndrome de Horner incompleto. En arteriografía renal y panangiografía cerebral realizada por Cardiología intervencionista se observó infarto renal derecho y disección de la carótida interna derecha con formación de pseudoaneurisma. Se hizo terapia endovascular con angioplastia y se dio de alta con antiagregación dual.Es importante conocer este tipo de presentación clínica ya que el diagnóstico podría confundirse con otras enfermedades que generan signos y síntomas similares; por consiguiente, es ideal tener sospecha clínica alta para evitar retrasos en el manejo. Abstract: Fibromuscular dysplasia is a non-inflammatory and non-atherosclerotic disease that can affect any arterial bed, with the renal and the internal carotid arteries being the most compromised.A case is presented on a patient that had abdominal pain and pain in the back of the head, and an incomplete Horner syndrome. In the renal arteriography and cerebral pan-angiography carried out by interventionist Cardiology, a right renal infarction and dissection of the right internal carotid was observed with a pseudo-aneurysm formation. Intravenous treatment was performed with angioplasty, and the patient was discharged with dual antiplatelet therapy.It is important to be aware of this type of clinical presentation, since the diagnosis can be confused with other diseases that produce similar signs and symptoms. It would be ideal to have a high clinical suspicion in order to avoid delays in the management.

Background: The net clinical benefit of mechanical thrombectomy (MT) in patients with anterior circulation ischaemic stroke associated with large vessel occlusion (AIS-LVO) related to carotid artery dissection (CAD) is uncertain. The aim of the study was to investigate the safety and clinical outcomes of patients treated by MT for a CAD-related stroke. Methods: We included consecutive patients with AIS-LVO treated by MT between 1st 2015 and January 1st 2020 at Lille University Hospital. We compared the safety and clinical outcomes, including successful recanalisation, defined as a modified thrombolysis in cerebral infarction (mTICI) ≥ 2b and favourable functional outcome at 3 months (defined as a modified Rankin Scale (mRS) ≤ 2 or equal to pre-stroke), in patients with CAD-related stroke versus patients with other aetiologies. Results: We included 1422 patients, among them, 43 patients with CAD-related AIS-LVO were matched to 86 patients with other aetiologies. Procedural complications, sICH (ECASS-3 criteria) and mortality rates were similar in the two groups (OR 0.85, 95% CI 0.21–3.49, p = 0.82; OR 1.54 95% CI 0.33–2.79, p = 0.58; OR 0.18 95% CI 0.02–1.46, p = 0.11, respectively), as well as the rates of intracranial angiographic successful recanalisation and favourable functional outcome (OR 0.67 (95% CI 0.26–1.73, p = 0.41; OR 1.26 (95% CI 0.61–2.64, p = 0.53). In patients with CAD-related stroke, intracranial angiographic success after MT was significantly associated with favourable functional outcome. Conclusions: In patients with AIS-LVO related to CAD, safety profiles and clinical outcomes after MT are similar compared to matched patients with other stroke aetiologies. [ABSTRACT FROM AUTHOR]

Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.

Objectives: Spontaneous recanalization of a chronic total occlusion of the extra-cranial internal carotid artery is an under-reported clinical entity. This paper reviews the different etiologies of internal carotid artery occlusion, its natural course, as well as the significance and our recommendations for the management of spontaneous internal carotid artery recanalization. Methods: A review of literature on etiology, diagnosis, and treatment of internal carotid artery occlusion and recanalization was conducted. PubMed database was searched using the terms "internal carotid occlusion" and "recanalization". Articles were reviewed and studies involving the management of internal carotid artery occlusion and spontaneous recanalization were included. We subsequently developed a management algorithm for chronic total occlusion of the internal carotid artery and spontaneous recanalization of such lesions based on the available evidence. Results: Common etiologies of chronic total occlusion of the internal carotid artery include carotid atherosclerotic disease, cardioembolic, and carotid dissection. Progression of an asymptomatic to symptomatic occlusion is estimated at 2–8% annually. Well-compensated patients can be asymptomatic. In others, clinical symptoms range from ipsilateral or global hypoperfusion to embolic stroke in some cases of spontaneous recanalization. Spontaneous recanalization occurs in 2.3–10.3% of patients but rarely results in a cerebrovascular event. Conclusions: Progression of an asymptomatic chronic total occlusion of the internal carotid artery to symptomatic is infrequent. The management algorithm of chronic total occlusion of the internal carotid artery and spontaneous recanalization of the internal carotid artery must be tailored to the patient based on symptoms, etiology of the lesion, imaging findings, surgical risk, and reliability for follow-up. [ABSTRACT FROM AUTHOR]

Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.

Takayasu arteritis is a rare vasculitis of unknown etiology. Inflammation primarily involves aorta and its branches in this disease. In our case, multislice computerized tomographic angiography showed total occlusion of right, and critical stenosis of left internal carotid and proximal part of left subclavian arteries. A conventional angiography was planned to implant a stent to left internal carotid artery, and to screen any coronary lesions. There was osteal stenosis of left anterior descending artery (LAD) on coronary angiography. Takayasu arteritis was diagnosed regarding Ishikawa criteria, and the patient was administered corticosteroids. After 3 weeks of corticosteroid treatment, it was decided to implant a stent to LAD and left internal carotid artery. Although coronary intervention was successful, the carotid intervention with stent was unsuccessfully due to rupture of the intimal plaque. The patient was taken into operating room urgently due to stent failure. First, saphenous vein was prepared from upper segment of knee of left leg. However diameter of the vein was insufficient to be used as a vascular graft. Left internal carotid artery was reconstructed with a patch of saphenous vein. Additionally, a cross over bypass was performed from right common carotid artery to left common carotid artery using a 7 mm polytetrafluoroethylene graft over saphenous vein. [Turk J Vasc Surg 2019; 28(1.000): 42-5]

Purpose: Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs' AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario. Methods: Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs' AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS ≤ 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. Results: Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 ± 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) ≤ 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002). Conclusion: In our real-life series, the EVT for TLs' AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen. [ABSTRACT FROM AUTHOR]

Cervical carotid artery dissections (CAD) usually produce ischemic symptoms as a result of thromboembolic phenomena, but hemodynamic insufficiency from flow-limiting stenosis can cause symptoms in a few patients [1]. CAD of the distal cervical and petrous ICA can be challenging to treat, particularly in the presence of vessel kinking or marked tortuosity of the distal cervical ICAs. The carotid stent systems used for atherosclerotic disease at the proximal ICA or carotid bulb are typically too stiff and large to safely track into a tortuous distal carotid artery, and the low radial force of the Pipeline flow diverter may occasionally result in inadequate flow restoration and even stent collapse in flow-limiting carotid dissections with large intramural thrombus burden [2,3]. In this paper, via 2 illustrative cases, we detail our experience with the latest iteration of the Neuroform stent system, the Neuroform Atlas (Stryker Neurovascular, Freemont, CA), for treatment of symptomatic flow-limiting distal cervical ICA dissections, with an emphasis on the advantages of the updated stent design.

Background Pheochromocytoma is an endocrine tumour secreting catecholamines, most often revealed by clinical symptoms (headache, palpitations, diaphoresis, or resistant hypertension). Some cases of ventricular arrhythmias were described in the literature, without any formal link between arrhythmia and pheochromocytoma. Case summary We report a case of pheochromocytoma discovered after cardiac arrest due to ventricular fibrillation in a 46-year-old patient. The diagnosis was suggested by clinical symptoms (headache, palpitation, and diaphoresis) and suspected on the abdominal computed tomography scan. The diagnosis was corroborated by metaiodobenzylguanidine scintigraphy and finally confirmed by anatomopathological analysis of the operative specimen. The cerebral imaging showed a dissection of the left internal carotid artery and an intraparenchymal haematoma that might be secondary to a catecholaminergic discharge of phaeochromocytoma and severe hypertension. Discussion Since pheochromocytoma is accessible to curative treatment, its detection in case of cardiac arrest is essential to decrease the risk of arrhythmic recurrence. [ABSTRACT FROM AUTHOR]

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Purpose: Aim of the study was to find answers to the following questions: What haemodynamic changes may occur in patients with stenotic, aneurysmal, dissection of the carotid artery and its branches? How do these changes differ in patients with normal and carotid disease? Material and methods: In order to achieve this aim, the cranio-cervical CT angiography images of patients who were referred to our clinic for any reason and received the diagnosis of carotid stenosis, carotid dissection, and extra or intracranial aneurysm were reviewed retrospectively. Results: Significant differences were detected in the carotid arteries of normal patients and those with aneurysm and dissection. When normal and aneurismal patients were compared, right and left ICA diameters (p = 0.000, p = 0.002, respectively), total ICA diameters (p = 0.000), carotid left Ø diameters (p = 0.026), right and left total Ø diameters (p = 0.024), and Murray's and our cosine values of Ø angles (p = 0.001 and p = 0.022, respectively) were found to be different. Also, in a comparison made between normal patients and patients with dissection, right CCA (p = 0.000), ICA (p = 0.001), ECA (p = 0.004) diameters, total CCA (p = 0.001), ICA (p = 0.009), and ECA (p = 0.003) diameters were also found to be different. Conclusions: This study showed that the presence of aneurysm plays an important role in the remodelling of the carotid arteries. Also, it is understood that Murray's laws are still valid for the detection of structural deterioration in carotid artery diseases. Hence, it is believed that these data can be used in artificial intelligence studies. [ABSTRACT FROM AUTHOR]

Background and Purpose: Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management. Materials and Methods: Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates. Results: A total of 7 patients were included. The mean age was 47 years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events. Conclusion: Reconstruction of the ICA as a rescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series. [ABSTRACT FROM AUTHOR]

Internal carotid artery occlusion accounts for 15-20% of ischemic strokes, caused by atherosclerosis or dissection. Clinical symptoms are variable, from asymptomatic cases to minor or severe strokes. Diagnosis in internal carotid artery (ICA) occlusion is based on imaging techniques. Prognosis after ICA occlusion depends on many factors: severity of neurologic deficit, spontaneous recanalization of the artery, and the occurrence of recurrent strokes. Patients with spontaneous recanalization of the occluded ICA tend to have a retained functional ability and favorable clinical outcomes. Medical treatment, recanalization techniques and intensive rehabilitation program are essential in improving functional outcome of patients with stroke produced by ICA occlusion. We present the case of a young patient diagnosed with ischemic stroke produced by internal carotid artery occlusion, with consecutive severe neurologic deficit, and an unfavorable functional outcome, as evaluated with the Modified Rankin Scale. Spontaneous recanalization of the occluded ICA was observed after 6 weeks, suggesting a carotid dissection. The patient was included in an intensive rehabilitation program, associated with best medical therapy, showing improvement of its functional status at 3 months follow up. [ABSTRACT FROM AUTHOR]

Background Mechanical thrombectomy is an effective treatment of acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be suboptimal. We present a patient with right common carotid artery (CCA) and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed. Case Description A 45-year-old man with a type A aortic dissection presented with sudden onset of neck pain and cold sweating. Aortic valve resuspension, proximal anastomosis of ascending aortic graft, partial aortic arch graft replacement, and innominate artery reimplantation was performed. After aortic surgery, left limb weakness was noted in the intensive care unit. Computed tomography angiography of the brain showed right CCA occlusion up to the internal carotid artery. The right CCA was exposed and directly punctured. A thrombus was successfully removed, and 5 stents were deployed to treat the internal carotid artery and CCA dissection. Angiography showed a final Thrombolysis In Cerebral Infarction 3 result, and the patient had an excellent clinical recovery. Conclusions Acute mechanical thrombectomy through open direct neck puncture to treat an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method. [ABSTRACT FROM AUTHOR]

Abstract A case of tandem occlusion consisting of right internal carotid artery (ICA) origin dissection and middle cerebral artery (MCA) thromoboembolism is reported. A 45 year-old male with right-sided neurological symptoms of emergent large vessel occlusion was treated with same-session angioplasty and mechanical thrombectomy of the respective lesions. The complete neurological recovery and radiological investigations are chronicled herein, and a review of the state of tandem occlusion management is discussed. Highlights • A case of tandem occlusion of right ICA origin dissection and MCA thromoboembolism is reported in a 45 year-old man. • Same-session angioplasty and mechanical thrombectomy of the respective lesions with complete recovery is chronicled. • Management is reviewed, including proximal-first and distal-first lesion intervention and the use of same-session stenting. [ABSTRACT FROM AUTHOR]

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO.Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO.Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00).Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD. [ABSTRACT FROM AUTHOR]

Purpose/Aim of the study: Carotid artery dissection (CAD) is a known causative factor in the etiology of acute ischemic stroke in young patients. However, the significance of CAD in older patients with acute ischemic stroke is unclear with only a few prior clinical studies. In order to isolate the influence of CAD as an independent factor, we performed multivariate analyses of common covariables in acute ischemic stroke patients in northern Israel. Materials and Methods: Three hundred and forty-seven consecutive patients who suffered from acute ischemic stroke had initial CT angiography (CTA) ordered from the emergency room. We reviewed the CTAs for radiologic signs of CAD, and recorded patients' demographic and clinical data from the hospital's computerized information system. Results: Eighteen of the 347 patients (5.19%) had CTA evidence of CAD, with no statistically significant differences based on age, gender or ethnicity. A statistically significant inverse association between hypertension and a lower rate of CAD was found before and after stepwise logistic regression, while hyperlipidemia showed a trend toward a similar inverse association that was borderline for statistical significance. Conclusions: Our study shows that CAD is an independent and significant causative factor for acute ischemic stroke. Therefore, diagnostic imaging is indicated to rule out CAD not only in young patients, but rather in all patients with acute ischemic stroke. The inverse correlation between common vascular risk factors (i.e. hypertension and hyperlipidemia) and CAD points to CAD as an independent nonatherosclerotic causative factor in the etiology of acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Background and Purpose: Small studies have suggested that Marfan syndrome is associated with a number of cerebrovascular complications. We sought to determine whether a clinical diagnosis of Marfan syndrome is associated with a higher prevalence of cerebrovascular diseases than the general population by performing a case-control study of hospitalized patients in the Nationwide Inpatient Sample (NIS).Methods: Using the 2000-2012 NIS, we performed a case-control study matching cases of Marfan syndrome to controls without such a diagnosis. The prevalence of various cerebrovascular diseases between the 2 groups were compared, and multivariate logistic regression was used to adjust for suspected comorbidities.Results: Between 2000 and 2012, there were a total of 13,883 discharges carrying a diagnosis of Marfan syndrome. On univariate analysis, patients with Marfan syndrome were more likely to have a primary or secondary diagnosis of hemorrhagic stroke (0.5% versus 0.3%, odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.06-2.29, P = 0.02) as well as intracranial hemorrhage (subarachnoid hemorrhage [SAH] and hemorrhagic stroke) (0.3% versus 0.2%, OR = 1.72, 95% CI = 1.05-2.82, P = 0.03). Patients hospitalized with Marfan syndrome were significantly more likely to have carotid dissection (0.3% versus 0.0%, OR = 11.69, 95% CI = 3.60-38.08, P <. 0001) and cerebral aneurysms (0.2% versus 0.1%, OR = 3.67, 95% CI = 1.76-7.68, P = 0.0002). On multivariate analysis adjusted for age, race, and comorbidities, patients with Marfan syndrome had significantly higher odds of ischemic stroke (OR = 1.20, 95% CI = 1.02-1.43, P = 0.03), hemorrhagic stroke (OR = 1.75, 95% CI = 1.18-2.63, P = 0.005), carotid artery dissection (OR = 11.94, 95% CI = 4.23-50.03, P < 0.0001), and cerebral aneurysm (OR = 3.95, 95% CI = 1.95-8.90, P <0.0001).Conclusions: There is a modestly increased prevalence of ischemic stroke, hemorrhagic stroke, and cerebral aneurysms in hospitalized patients with Marfan syndrome when compared with controls. [ABSTRACT FROM AUTHOR]