Intracarotid Ultrasound Imaging of Dissection Involving the Internal Carotid Artery. Technical Case Report.

Intravascular ultrasound sonography was employed in a patient with traumatic dissection of the cervical internal carotid artery (ICA) . A 21-year-old male presented with right hemiparesis and motor aphasia 36 days after a motorcycle accident. CT and MR imaging showed an infarction in the left middle cerebral artery area. Cerebral angiograms showed dissection and pseudoaneurysm in the left cervical ICA. Intravascular ultrasound images demonstrated multiple dissections of the ICA beginning at the C2 vertebral level up to the carotid canal. The extent of the dissection was larger than that shown by angiography. The minimum diameter of the true lumen was 3.0 mm. Balloon expansion to deliver short stents carried a high risk of distal embolism, and the diameter of the true lumen was not large enough to allow placement of a long stent. As a result, ligation of the proximal ICA combined with anastomosis of the superficial temporal artery to the middle cerebral artery was chosen as the treatment. Intravascular ultrasound imaging was useful for evaluating the morphology of the dissection and the true lumen in the cervical ICA and for selecting an appropriate treatment.