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Dissection of Cervical Segment Internal Carotid Artery
Šercl, Miroslav ; Raupach, Jan (advisor) ; Köcher, Martin (referee) ; Beneš, Vladimír (referee)
Aims: The main aim of this study is to analyse the effectiveness, safety and causal relationships of treatment of patients with carotid artery dissection arising spontaneously, due to trauma or from an iatrogenic cause. Methods: In all patients, we analyzed baseline clinical symptomatology and NIHSS, findings on initial CTA (ev. DSA), selected therapy in the acute phase, follow-up brain imaging, medication at discharge, and clinical findings at 3 months with assessment of NIHSS and mRS with carotid artery imaging by ultrasound or CTA. The first group consisted of 38 patients with spontaneous ICA dissection. Currently asymptomatic patients after a resolved TIA or patients with NIHSS ≤ 3 were treated conservatively with antiplatelet or anticoagulation therapy. Patients with significant neurological deficit (NIHSS ≥ 4) were treated with intravenous thrombolysis, or stent implantation in the neck dissection area, mechanical thrombectomy of the distal emboli, or a combination of all methods. The second group included 16 patients with traumatic ICA dissection diagnosed on whole- body CT scan as part of the post-trauma evaluation. Patients with brain injury or major bleeding lesions were kept without antithrombotic therapy until their condition stabilized with early switch to anticoagulation therapy with...
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