Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion

Abstract

Dissection of the internal carotid artery (ICA) is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT), resulting in occlusion of the ICA.

Keywords: Dissection; Internal Carotid Artery; Magnetic Resonance Angiography; Neurointerventional Procedure.

Figure 1.. A 66-year-old woman with middle cerebral artery thrombosis underwent stent-assisted thrombectomy. A, Cranial axial reformatted MRA performed at the time of admission showed a thrombus occluding the left ICA extending to the supraclinoid segment. Left MCA flow was from the anterior communicating artery; B, Cranial digital subtraction angiography demonstrated the guiding catheter at the distal part of the left ICA cervical segment and the occlusion of the left MCA; C, Cranial digital subtraction angiography showed a focal, nonprogressive ICA dissection at the distal cervical segment and recanalization of the MCA. Note the patient’s left ICA segment.

Figure 2.. Contrast-enhanced coronal reformatted craniocervical MRA demonstrated the occluded left ICA extending from the proximal segment to the supraclinoid segment.