Patient presentation, angiographic features, and treatment of strangulation-induced bilateral dissection of the cervical internal carotid artery - Report of three cases

Domestic violence leading to strangulation by an abusive spouse can cause c arotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strate gies in three additional cases. Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of t he patients suffered delayed cerebral infarctions before presentation and a ngiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplas ia. One of these patients underwent unilateral percutaneous angioplasty wit h stent placement, and the other underwent bilateral percutaneous angioplas ty. Both patients have recovered from their strokes and remain clinically s table at 8 and 20 months posttreatment, respectively. The third patient pre sented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent o f the established infarctions, this case was managed with a long-term regim en of anticoagulation medications, and the patient remains neurologically i mpaired. These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in w hich percutaneous angioplasty and/or stent placement are used can be useful in treating residual Focal stenoses to improve cerebral perfusion and to l ower the risk of embolic or ischemic stroke.