Endovascular Flow Diversion in Cervical Internal Carotid Artery Dissections

Extracranial artery dissections (EADs) represent leading causes of stroke in young patients, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. In this technical video, we present 2 adult patients with cervical internal carotid artery (ICA) dissection treated with flow diverters (Video 1). The first patient come to our attention without symptoms. He had a history of acute ischemic stroke owing to dissection of the right cervical ICA in 2013. He was on double antiplatelet therapy, and he had recurrent colorectal bleeding. Magnetic resonance imaging confirmed right frontal gliosis and occlusion of the right ICA with collaterals from the external carotid artery and showed a double lumen dissection of the left cervical ICA. The second patient was admitted to our emergency department with right tongue and vocal cord palsy. Computed tomography documented 2 carotid pseudoaneurysms, the bigger one on the right side. Flow diversion was successful in both patients. In 15%–20% of patients with EAD, multiple cervical arteries are affected. In EAD, stenosis resolution or recanalization occurs in 33%–90% of patients within 6 months. Dissecting aneurysms are reported to resolve or decrease in size in 40%–50% of patients, but can also increase in size. There are currently no controlled clinical trials comparing endovascular therapy and antithrombotic treatment with antithrombotic therapy alone in patients with carotid EAD, and only some reports have demonstrated the efficacy of angioplasty and stenting. However, we recommend some further reading on this topic.1-5