SPONTANEOUS CAROTID-ARTERY DISSECTION - CASE-REPORTS AND REVIEW OF THE LITERATURE

A review of the authors' experience with spontaneous carotid artery di ssections and a comparison of their management strategies and outcomes with a review of the recent literature are presented. A retrospective chart analysis revealed 5 cases over the past nine years. All were tr eated in a conservative fashion. Two underwent anticoagulation, 2 rece ived antiplatelet therapy, and 1 was merely observed. Their ages range d from thirty-eight to eighty-three and all were men. Four of the 5 (8 0%) went on to an uneventful recovery. One patient receiving anticoagu lation developed total occlusion of the left internal carotid artery a ssociated with an acute stroke. Angiography is the gold standard for d iagnosis, but the role of duplex ultrasound for diagnosis and follow-u p has strengthened. Of patients with spontaneous carotid artery dissec tion, 85-90% have an uneventful recovery, and surgical intervention is rarely indicated.