A novel treatment for symptomatic carotid dissection

Carotid dissection is a rare but significant cause of stroke. The neurological damage in such cases is mainly attributable to thromboembolism.1 Current treatment includes supportive therapy and antiplatelet agent either alone or with anticoagulation. This is not supported by randomised trials2 but it is logical. Presence of microemboli in cerebral circulation is a risk factor for ischaemic stroke after transient ischaemic attack (TIA)3 and transcranial Doppler examination (TCD) can detect them in middle cerebral artery circulation.4 Controlling microemboli improves the outcome in recurrent TIA and after carotid endarterectomy.5,6 We found this strategy effective in the treatment of a symptomatic carotid dissection unresponsive to anticoagulation. We report a case of carotid artery dissection treated successfully by controlling microemboli from the dissected artery and discuss its validity. A 45 year old, right handed man presented with a severe left sided headache, fluctuating weakness, and numbness in his right arm. He also had temporary loss of vision in his left eye and dysphasia. He reported a twisting movement of his neck eight days before this. In the past he had migraine and he was hypertensive. Physical examination confirmed expressive dysphasia, mild weakness of his right arm muscles, and impaired sensation. His pulse was regular and his blood pressure was normal. He had normal blood parameters including lipids. Aspirin and clopidogrel were started after confirming multiple low attenuation areas in …