Asymptomatic postendarterectomy dissection of the internal carotid artery detected incidentally on MRI.

A patient who had recently undergone carotid endarterectomy was found to have internal carotid artery dissection on an MRI examination. This is a supposedly rare complication of this frequently performed operation. Since most patients with dissection of the ICA (from whatever cause) are symptomatic when the diagnosis is made, its incidental detection in an asymptomatic patient suggests that this complication may be commoner than generally recognised. We review the ways in which carotid dissection may occur during endarterectomy and the differential diagnosis of the MRI appearances.