A Case of Internal Carotid Artery Dissection Presenting Acute Intracranial Occlusion and Accompanied with Simultaneous Carotid Cavernous Fistula Treated by Thrombectomy

Abstract

Objective: We report a case of internal carotid artery (ICA) dissection presenting acute intracranial occlusion and accompanied with simultaneous carotid cavernous fistula (CCF) treated by thrombectomy. Case Presentation: The patient was a 43-year-old male who presented with severe neurological symptoms. Imaging findings demonstrated acute ischemic stroke with occlusion of the left ICA. A retrospective review of angiogram showed ICA dissection-related occlusion with a fine CCF. However, dissection could not be recognized initially, and thrombus aspiration with Penumbra system was performed as revascularization therapy. Recanalization of the ICA was not achieved and the CCF deteriorated. Considering the risk of hemorrhagic complications and the treatment of CCF, parent artery occlusion of the ICA was conducted. The CCF disappeared; however, an extensive area of the left middle cerebral artery territory was infarcted. Conclusion: In revascularization for acute ischemic stroke, it is important to adequately evaluate the condition such as dissection and to select an appropriate therapeutic strategy.