Traumatic carotid artery dissection without head or neck trauma: a case report following thoracoabdominal crush injury

Traumatic carotid artery dissection (tCAD) bears the risk of hypoperfusion inducing delayed cerebral ischemia. The lack of consensus on standard treatment of tCAD remains a great challenge. Here, we present our successes on a series of patients with delayed tCAD diagnosis and treatment using multimodality treatment strategies. We retrospectively reviewed 21 patients with tCAD treated with carotid artery stent placement or anticoagulation therapy. There were 14 dissection locations (66.67 %) which involved extracranial internal carotid artery (ICA) and seven locations (33.33 %) which involved both extracranial and intracranial ICA. Stenosis severity was 70–99 % in 16 cases (76.19 %) and <70 % in 5 cases (23.81 %). Endovascular stents were administrated to 17 patients with hypoperfusion as evaluated by radiological methods, while anticoagulation therapy was administrated to the other four patients. Carotid revascularization was performed with one (9/17 patients) or multiple (8/17 patients) stents. None of the patients experienced a procedure-related complication. At discharge, the mean modified Rankin Scale (mRS) score of patients was 1.08 ± 0.76. Neither additional neurological deficient nor restenosis happened during the follow-up period. More vigilance is required to assure timely diagnosis of patients with delayed tCAD. Assessment of cerebral perfusion is an effective approach in tCAD treatment in our experience.