SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID-ARTERY - A 19-YEAR CLINICAL-EXPERIENCE

Purpose: This article reviews our experience with internal carotid art ery dissection (ICAD), evaluates the usefulness of Duplex scanning in diagnosis, provides current recommendations for treatment, and better defines long-term prognosis. Methods: The records from 1976 to 1995 of 24 patients who had 28 ICAD were reviewed. All diagnoses were confirm ed by arteriography. Presenting symptoms, diagnostic tests, clinical m anagement, and outcome were examined. Results: Nine patients had visua l symptoms or headache, 10 had transient focal neurologic symptoms (TI A), and five had stroke. Five of the 19 who had visual symptoms or TIA had a stroke before the diagnosis of ICAD. Seventeen patients who had 19 ICAD underwent a Duplex scan at the time of presentation. Duplex s can identified 18 arterial abnormalities consistent with ICAD (sensiti vity, 95%). Three patients died from stroke during the initial hospita lization. Of the 21 who survived, 12 were treated with anticoagulation therapy, six with aspirin, and three with aspirin and anticoagulation therapy, None of the 21 patients had a subsequent stroke. Six patient s subsequently had an operation for residual occlusive disease or aneu rysm. The mean duration of follow-up was 9.3 years. Two patients devel oped contralateral ICAD. During follow-up, 19 arteries were studied wi th Duplex scan, and seven had no residual evidence of ICAD. Conclusion s: Patients who have ICAD often have prodromal symptoms before stroke. If diagnosed early, treatment with anticoagulation may prevent stroke . Duplex scans are accurate for defining carotid abnormalities consist ent with ICAD and for indicating the need for arteriography. Patients should undergo a follow-up Duplex scan to identify contralateral ICAD.