Treatment of cervical internal carotid artery dissection resulting in intracranial large vessel occlusion treated by mechanical thrombectomy

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  • Nakamura Rika
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
  • Dofuku Shogo
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
  • Aoka Takashi
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
  • Tsunogae Marie
    Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center
  • Ohara Kenta
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
  • Sato Masayuki
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center
  • Ueda Masayuki
    Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center
  • Ota Takahiro
    Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center

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Other Title
  • 急性頭蓋内主幹動脈閉塞を来し機械的血栓回収療法を施行した頚部内頚動脈解離に対する治療選択

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Abstract

<p> Objective: To review the treatment of cervical internal carotid artery dissection resulting in intracranial large vessel occlusion. Methods: Two hundred and ninety patients who underwent mechanical thrombectomy at our hospital from April 2015 to March 2022 were included. The diagnosis was comprehensive, including clinical symptoms and imaging findings. Initial symptoms, neurological findings, images, treatments, and outcomes were collected retrospectively. Results: The study included five patients (2%) with cervical internal carotid artery dissection. The mean age of the patients was 47 years, accounting for 26% (4/19) among those under 55 years. Only two of the five patients presented with head or neck pain. For cervical internal carotid artery dissection, three patients underwent percutaneous transluminal angioplasty. Of these three patients, one patient underwent parent artery occlusion and another underwent carotid artery stenting one month later. The other two patients were treated conservatively for internal carotid artery dissection. All patients showed improved symptoms after treatment. Conclusion: Internal carotid artery dissection is a common cause of severe stroke in young patients, even in the absence of pain. Mechanical thrombectomy is effective in the treatment of intracranial large vessel occlusion due to cervical internal carotid artery dissection. Good outcomes were achieved in this study with individualized case-specific treatment.</p>

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