Stent Placement for Idiopathic Internal Carotid Artery Dissection in the Petrous Portion : A Case Report

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  • 錐体骨部特発性内頚動脈解離に対するステント留置術の1例

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  The epidemiology of idiopathic intracranial internal carotid artery dissection is unclear and there are few reports on stent placement for these lesions. A 54-year-old male was admitted to our hospital with gait disturbance following severe throbbing retrobulbar pain for two days. He was unconscious with slight left hemiparesis. Magnetic resonance imaging (MRI) showed a fresh cerebral infarction in the right temporal lobe. Digital subtraction angiography revealed severe stenosis of the internal carotid artery at the petrous portion ; therefore, we diagnosed the condition as idiopathic carotid artery dissection. The fluctuation of the consciousness level indicated a hemodynamic disorder ; therefore reconstruction of the blood flow was attempted by stent placement. Emergency stent placement with a PALMAZTM GenesisTM stent (Cordis® Johnson & Johnson, Miami, FL, USA) and PRECISE® PRO RX® Carotid Stent System (Cordis® Johnson & Johnson, Miami, FL, USA) achieved favorable dilatation of the stenosis followed by almost complete remission of the symptoms. Idiopathic internal carotid artery dissection can be successfully treated with stent placement ; however, several difficulties concerning the technique and instruments need to be overcome to achieve safer intervention. Headache accompanied by a focal cerebral ischemic sign permit definite diagnosis of this condition ; therefore, an accurate and exact history of the present illness is very important for early application of the most appropriate therapy.

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