Spontaneous bilateral internal carotid and vertebral artery dissections with dominant-hemisphere circulation maintained by external carotid artery-ophthalmic artery anastomoses. 2019

Danielle Golub, and Lizbeth Hu, and Siddhant Dogra, and Jose Torres, and Maksim Shapiro
1Department of Neurosurgery.

Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections. Collateral response involved extensive external carotid artery-internal carotid artery anastomoses via the ophthalmic artery, which were instrumental in maintaining perfusion because circle of Willis and leptomeningeal anastomotic responses were hampered by the dissection burden in the corresponding collateral vessels. Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009880 Ophthalmic Artery Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures. Arteries, Ophthalmic,Artery, Ophthalmic,Ophthalmic Arteries
D002340 Carotid Artery Diseases Pathological conditions involving the CAROTID ARTERIES, including the common, internal, and external carotid arteries. ATHEROSCLEROSIS and TRAUMA are relatively frequent causes of carotid artery pathology. Carotid Atherosclerosis,Common Carotid Artery Disease,Internal Carotid Artery Disease,Arterial Diseases, Carotid,Arterial Diseases, Common Carotid,Arterial Diseases, External Carotid,Arterial Diseases, Internal Carotid,Atherosclerotic Disease, Carotid,Carotid Artery Disorders,Carotid Atherosclerotic Disease,Common Carotid Artery Diseases,External Carotid Artery Diseases,Internal Carotid Artery Diseases,Arterial Disease, Carotid,Artery Disease, Carotid,Artery Diseases, Carotid,Artery Disorder, Carotid,Artery Disorders, Carotid,Atherosclerotic Diseases, Carotid,Carotid Arterial Disease,Carotid Arterial Diseases,Carotid Artery Disease,Carotid Artery Disorder,Carotid Atheroscleroses,Carotid Atherosclerotic Diseases,Disorders, Carotid Artery
D002342 Carotid Artery, External Branch of the common carotid artery which supplies the exterior of the head, the face, and the greater part of the neck. Arteries, External Carotid,Artery, External Carotid,Carotid Arteries, External,External Carotid Arteries,External Carotid Artery
D002343 Carotid Artery, Internal Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose. Arteries, Internal Carotid,Artery, Internal Carotid,Carotid Arteries, Internal,Internal Carotid Arteries,Internal Carotid Artery
D003097 Collateral Circulation Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. Blood Circulation, Collateral,Circulation, Collateral,Collateral Blood Circulation,Collateral Circulation, Blood,Blood Collateral Circulation,Circulation, Blood Collateral,Circulation, Collateral Blood,Collateral Blood Circulations,Collateral Circulations,Collateral Circulations, Blood
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000069322 Self Expandable Metallic Stents Cylindrical metallic tubes that are inserted to hold open a structure in order to treat vascular, bile duct, esophageal and other tubular organ constrictions. Self Expandable Metal Stent,Self Expandable Metal Stents,Self Expandable Metallic Stent
D000714 Anastomosis, Surgical Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side. Surgical Anastomosis,Anastomoses, Surgical,Surgical Anastomoses

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