Emergency stenting of an acute internal carotid artery occlusion from spontaneous dissection.

SUMMARY: Internal carotid artery (ICA) dissection is an important cause of stroke in the younger population. Carotid stenting with or without angioplasty is usually the preferred treatment for symptomatic patients who have failed medical therapy. We report a case of a symptomatic internal carotid artery dissection at the petrous segment of the ICA initially treated conservatively with anticoagulation and antiplatlet agents. Due to early clinical deterioration from near complete carotid occlusion without adequate cross over flow, the patient underwent emergency stenting of the ICA. Post procedure angiography demonstrated no residual stenosis of the ICA. The patient progressively improved and at six months followup, the patient had no further symptoms, a normal neurological examination and improvement in the imaging findings. The successful clinical result in our case of ICA stenting for dissection as a 'hemispheric rescue' contributes to the growing literature of endovascular management of carotid dissection. The excellent mid term follow-up confirms the efficacy of this treatment for a dominant ICA.