Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4773-4784
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4773
Cerebral infarct secondary to traumatic internal carotid artery dissection
Guang-Ming Wang, Hang Xue, Zhen-Jie Guo, Jin-Lu Yu
Guang-Ming Wang, Hang Xue, Zhen-Jie Guo, Jin-Lu Yu, Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Yu JL contributed to case conceptualization; Xue H and Wang GM contributed to data curation; Guo ZJ contributed to manuscript drafting; Wang GM and Yu JL contributed to manuscript review and editing.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the First Hospital of Jilin University.
Informed consent statement: Informed consent for publication of these cases was obtained from the patients or their relatives.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Lu Yu, MD, MSc, PhD, Doctor, Professor, Department of Neurosurgery, The First Hospital of Jilin University, No. 71 Xinmin Avenue, Changchun 130021, Jilin Province, China. jlyu@jlu.edu.cn
Received: April 23, 2020
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
ARTICLE HIGHLIGHTS
Research background

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).

Research motivation

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.

Research objectives

We performed a retrospective analysis and literature review of patients who were diagnosed as TICAD.

Research methods

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.

Research results

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.

Research conclusions

We found that TICAD should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion.

Research perspectives

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.