Endovascular treatment of carotid dissecting aneurysms

Background and Purpose: Cervical arterial dissection is a well-recognised c ause for acute ischaemic stroke. Dissecting aneurysms commonly occur in the affected vessels contributing to the clinical presentation. Persistence of these aneurysms may provide a source of future embolic events as well as c ausing local symptoms or even be at risk of spontaneous rupture. Methods: W e describe 4 patients with traumatic internal carotid artery (ICA) dissecti ons with aneurysm formation at the skull base. Three of the 4 patients stil l had carotid aneurysms on follow-up investigations and so underwent endova scular procedures using stenting and coil techniques. The carotid aneurysm resolved spontaneously in the fourth patient. Results: The endovascular pro cedures resulted in significant reduction or obliteration of the flow withi n the carotid aneurysms with restoration of the true lumen diameter in the adjacent ICA in all 3 patients, No perioperative complications were experie nced except for transient headache in 2 patients. Conclusions: In patients with persistent aneurysms the exact risk of subsequent ischaemic events rem ains unknown and prospective long-term studies are needed to ascertain this risk. If recurrent stroke rates are found to be high, then carotid stentin g (with or without coil insertion) is a feasible invasive approach which co uld be considered in these patients.