45 year old male assaulted directly to the face multiple times with a heavy blunt object sustained injuries by a hyperextension/rotation mechanism. His neurologic status was difficult to assess due to diffuse axonal brain injury. A screening angiographic examination of the cervical vessels was performed
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  • There is minimal filling of the cervical portion of the internal carotid artery (ICA) by a narrow column of contrast filling the distal ICA. The diameter of the ICA is markedly diminished , and there is a persistent radiolucent filling defect involving nearly the entire length of the cervical ICA. In addition, there is markedly delayed filling of the petrous portion of the ICA on image 1-2. this is noted by complete washout of contrast from the external carotid artery, with an early arterial appearance to the ICA distribution.
  • DX = traumatic carotid dissection.
  • Ddx = Iatrogenic carotid artery dissection; fibromuscular disease with secondary arterial dissection.
  • Tx = Wallstent was placed across the dissection with a good angiographic response. Coronary stents are used because of their flexibility, and because they can be placed over small (.018 diameter) guidewires; small wires are used because of the lower propensity to form thrombus and because of the potential decreased risk of worsening the underlying injury

 

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