Endovascular Stenting for the Treatment of an Initially Asymptomatic Patient with Traumatic Carotid Artery Dissection

Carotid dissection is a rare lesion after head injury and is often known to occur in the case of direct neck trauma.Although most of the carotid artery dissection occurs spontaneously, approximately 4% is associated with severe trauma [1].For example, major blunt trauma resulting from high-speed motor vehicle accidents [2].Clinical presentation encompasses a wide range of symptoms, often leading to a delay in diagnosis.Asymptomatic carotid artery injury may not be easily detected during clinical evaluation of head and neck trauma [3,4]. CaseA 78-year-old woman was admitted after being hanging while experiencing a cart wearing a scarf 1 day ago.She had a history of hypercholesterolemia.The neck computed tomography (CT) scan showed bilateral common carotid artery dissection (Figure 1A and B), with patent blood flow and hematoma with swelling in the pretracheal area (Figure 1C).However, the true and false lumen could not be clearly distinguished and the true lumen was not compressed (Figure 1D).There was no problem with perfusion through the bilateral internal carotid artery.The patient was hemodynamically stable and without neurological deficits.We planned followup CT after 3 days and the patient will be transfer to her home region if there is no change in the lesion.Three days later, the patient complained of sudden severe dizziness.Patients were drowsy on the day of imaging follow-up with nausea and poor oral intake, and the Glasgow Coma Scale decreased from 4-5-6 to 3-4-6.Therefore, emergency transfemoral cerebral angiography and diffusion magnetic resonance imaging were performed.The magnetic resonance imaging showed multiple tiny high signal in-