Spontaneous Bilateral Internal Carotid Arteries Dissection with Acute Stroke - A Case for Stent Implantation and Antithrombotic Therapy and Literature Review

Background Internal Carotid Arteries Dissection (ICAD) is a rare but important cause of severe acute ischemic stroke. Patients with ICAD are mostly treated with the antithrombotic regimen (anticoagulation, signal antiplatelet and dual antiplatelet), or endovascular treatment. The recurrence rate of carotid artery dissection stroke is relatively low. Here, we present a case of middle-aged male patient with acute ischemic strokes was caused by spontaneous bilateral ICAD. Stent placement in combine with antiplatelet therapy is a beneficial treatment method for such patient, as a preferred option. Case presentation: We present a case of a 54 -year-old male with no history of arteriopathy who presented with left limber weakness and slurred speech. Cerebral magnetic resonance imaging (MRI) showed acute large area cerebral infarcts in the right hemisphere. Digital subtraction angiography (DSA) demonstrated that the right internal carotid artery (ICA) occlusion at the cervical portion. He was found to have dissections in the right intracranial carotid arteries. He was treated with dual antiplatelet therapy and right carotid artery stent implantation. However, the patient still developed new neurological deficits, after stenting and balloon dilatation in the right carotid artery and postoperative antiplatelet therapy. MRI showed that acute left cerebral hemisphere infarction. Cervical computed tomography angiography and DSA revealed status of right carotid artery stent implantation and left ICA occlusion. Similarly, stent was performed in his left carotid artery, and dual antiplatelet therapy still continued. He was seen in the clinic at 6 months with follow-up imaging revealing improvement in the dissections. Conclusion The preferred option for patients with ICAD is to receive medication. If the ischemic event still occurs, invasive treatment should be carried out. However, ischemic stroke events were treated effectively with stenting and postoperative antiplatelet therapy.