Spontaneous Dissection of the Internal Carotid Artery: Partially Collateralized Dissecting Carotid Artery Occlusion; Improved Chance of Recanalization Under Conservative Management with Combined Antiaggregation and Anticoagulation

A 52-year-old patient presented with an acute hypertensive crisis. The occurrence was preceded by an episode of neck pain during alpine skiing with a violent head movement a few weeks before. Diagnostic imaging revealed a left side internal carotid artery occlusion due to dissection with vessel wall hematoma. Focal neurologic symptoms were mild. However, the hemodynamic condition proved to be critical since lowering the elevated arterial blood pressure caused transient loss of consciousness with tetraparesis. We decided on aggressive conservative treatment, combining two antiaggregation drugs with anticoagulation. The vessel re-opened spontaneously during the following days, and the patient was discharged home without remaining symptoms. Early and mid-term follow-up examinations under ongoing medication showed good recanalization of the previously dissected, occluded vessel, eventually with no traces of the former dissection after some months. The main topic of this chapter is the conservative management of at least partially collateralized spontaneous dissections of the internal carotid arteries with dual antiaggregation and anticoagulation.