Carotid artery stenting to prevent stroke in a patient with bilateral extracranial internal carotid dissection and vasospasm following rupture of an intracranial aneurysm

Abstract

The stenting of carotid dissection has been described for the prevention of cerebral ischemia in patients who remain symptomatic despite therapeutic anticoagulation, in those who present contraindications for anticoagulation therapy, or who present a local or extensive stenosis, with an associated pseudoaneurysm. We here report a case associating a high clinical grade aneurysmal rupture with a bilateral extracranial carotid dissection. Because of the haemodynamic risk due to the acute bilateral stenosis-induced dissection and the occurrence of a vasospasm, the carotid dissections were treated with self-expendable stents.

Figure 1

Lateral view of the vertebro-basilar system, showing a left PICA aneurysm before and after endovascular coiling.

Figure 2

Digital subtraction angiography of the right and left common carotid arteries reveals right middle cerebral artery aneurysm, associated with moderate and staged stenosis of both cervical internal carotid arteries diagnosed as dissection or fibromuscular dysplasia.

Figure 3

Digital subtraction angiography of both common carotid arteries showed progression of the dissections, despite systemic anticoagulation, with a long-segment stenosis and expansile pseudoaneurysms.

Figure 4

Anteroposterior projection of the right and left internal carotid angiograms showing arterial vasospasm.

Figure 5

Right and left carotid angiograms realized four months, after stenting, showing good patency of the arterial lumen with a residual stenosis of the left internal carotid artery just beneath the proximal part of the stent.