Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4773
Peer-review started: April 23, 2020
First decision: April 29, 2020
Revised: August 16, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: October 26, 2020
Processing time: 186 Days and 2.6 Hours
The extracranial internal carotid artery refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally and is at considerable risk for injury. No consensus regarding its diagnostic screening and management has been established. The present study compared the outcomes of six different patients who suffered traumatic internal carotid artery dissection (TICAD).
Despite a high incidence, reports of TICAD are limited to case reports or small case series. Currently, the frequency, cause, imaging changes, and influence on mortality of TICAD are not well defined. We therefore decided to conduct a retrospective study of TICAD at a tertiary medical center. The risk factors of infarction, pathophysiology, clinical and radiological features, diagnosis, treatment, and prognosis were analyzed and delineated for TICAD.
We performed a retrospective analysis and literature review of patients who were diagnosed as TICAD.
In this retrospective case series, emergency admissions for TICAD due to closed head injury were analyzed. The demographic, clinical, and radiographic data were retrieved from patient charts and the picture archiving and communication system, and a literature review of TICAD was also performed.
Six patients presented with TICAD. Traffic accidents (4/6) were the most frequent cause of TICAD. The clinical presentation was always related to brain hypoperfusion. Imaging examination revealed dissection of the affected artery and corresponding brain infarction. All the patients were definitively diagnosed with TICAD. One patient was treated conservatively, one patient underwent anticoagulant therapy, two patients were given both antiplatelet and anticoagulant drugs, and two patients underwent decompressive craniectomy. One patient fully recovered, while three patients were disabled at follow-up. Two patients died of refractory brain infarction.
We found that TICAD should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion.
Early diagnosis and intervention can improve the prognosis and quality of life of patients who suffered TICAD. Based on the results of this study, future research should include prospective randomized control trial with a larger patient population so that we can better understand the diagnosis and treatment of TICAD.