Extracranial internal carotid artery dissections: noniatrogenic traumatic lesions
G. B. Zelenock, A. Kazmers, W. M. Whitehouse Jr, L. M. Graham, E. E. Erlandson, J. L. Cronenwett, S. M. Lindenauer and J. C. Stanley
Noniatrogenic traumatic extracranial internal carotid artery dissections
were encountered in six patients (five men and one woman) 31 to 62 years
old. All but one had overt cerebral ischemia manifest by paresis (three),
sensory deficits (three), aphasia (three), or amaurosis fugax (two), One
patient had an asymptomatic carotid artery bruit. Cerebral arteriography
established the diagnosis in all cases. Internal carotid artery impingement
between the mandible and transverse processes of the second and third
cervical vertebrae, or undue stretching over these vertebral structures,
were the most likely primary mechanisms of injury. Secondary complications,
a result of distal thromboembolism, were evident in two patients. Direct
cerebral revascularization, staged internal carotid artery constriction and
ligation, as well as intensive nonoperative therapy were valid therapeutic
options. There were no deaths. Treatment relieved transient ischemic
symptoms or arrested progression of established neurologic deficits in each
case. In select patients, early surgical intervention may lessen attending
neurologic sequelae.
