Carotid artery dissection recanalization: imaging modalities, influencing factors, and therapeutic perspectives

Abstract

Carotid artery dissection (CAD) is a rare cause of ischemic stroke, and its prognosis is often poor. If not diagnosed and treated in time, it may lead to serious complications such as intracranial stroke and even death. Accurate diagnosis of CAD, formulation of reasonable treatment plans, and prediction of vascular recanalization are crucial for improving the prognosis of patients. However, there is currently a lack of large-scale randomized controlled trials to provide guidance for clinical practice, and the industry has not yet reached a unified consensus on the standardized diagnosis and treatment of CAD. Therefore, this article reviews the imaging examination methods for recanalization of CAD, the analysis of related factors affecting recanalization, and the methods of recanalization treatment, and combines the latest research progress to provide a perspective on the recanalization of carotid artery dissection, aiming to provide a reference basis for the precise diagnosis and treatment of CAD recanalization.

Keywords: carotid artery dissection; decision making; diagnostic imaging; revascularization; treatment outcome.

Figure 1

The process of recanalization for carotid artery dissection.

Figure 2

Cervical artery dissection showing arterial dissection-related vascular changes (right internal carotid artery). (A,B) Axial images of the right internal carotid artery. The structure indicated by the arrow represents the "double lumen sign," where the intimal flap divides the vascular lumen into two parts. (C,D) Coronal and sagittal images of the right internal carotid artery, respectively. The structure indicated by the arrow represents the "double lumen sign".

Figure 3

High-resolution magnetic resonance imaging showing arterial dissection-related vascular changes. (A,B) Axial images of the left internal carotid artery. The crescent-shaped high signal indicated by the arrow represents an "intramural hematoma." (C,D) Coronal and sagittal images of the left internal carotid artery, respectively. The high-signal structure indicated by the arrow represents an "intramural hematoma".

Figure 4

Arterial dissection is observed in the left vertebral artery. The posterior wall of the left vertebral artery shows an intramural hematoma, resulting in luminal narrowing, with a residual diameter of 1.9 mm and an original diameter of 4.5 mm.

Figure 5

Digital subtraction angiography reveals vascular changes due to arterial dissection in the left internal carotid artery. The DSA image clearly demonstrates evidence of dissection in the left internal carotid artery, with the arrow pointing to a structure consistent with the 'flame sign,' characteristic of this condition.