Clinical Features and Treatment of Spontaneous Cervical Internal Carotid Arterial Dissection

Spontaneous cervical internal carotid arterial dissection (SCICAD) is a common cause of ischemic stroke in younger patients (age ＜50 years). However, the underlying mechanism and pathophysiology are not fully understood, and a standard criterion for the treatment has not been established; therefore, we reviewed seven cases of SCICAD treated between 2013 and 2018 to determine the appropriate treatment. Headaches, orbital pain, or neck pain occurred in six cases. Six patients with SCICAD had an acceptable clinical course with medical therapy alone. Carotid artery stenting (CAS) was performed for three lesions in three patients. One patient was treated with CAS and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Another patient was treated with CAS with endovascular mechanical thrombectomy. A favorable functional outcome was observed in all cases, and antithrombotic therapy with an anticoagulant or antiplatelet drug was essential. Most patients are successfully treated with low recurrence rates; however, endovascular treatment is a viable option for drug-resistant cases.