False Lumen Stenting to the Acute Occlusive Carotid Artery Dissection Combined With Intracranial Acute Embolic Stroke: A Case Report and Literature Review

Abstract

Tandem occlusion due to acute cervical carotid artery dissection should be promptly treated with thrombectomy for reperfusion. If the cervical lesion has reached severe stenosis or complete occlusion, balloon angioplasty and, in certain cases, carotid artery stenting should be performed before thrombectomy for the intracranial lesion. Angioplasty or stent placement is performed in the true lumen, but securing the placement is challenging when the true lumen cannot be determined. In contrast, stenting in the false lumen of a carotid artery dissection is considered contraindicated. Although reports on a few similar cases have been published, no obvious complications are known, and the actual risks and outcomes remain unclear. We report the case of a 49-year-old woman with acute ischemic stroke who had tandem occlusion of the cervical internal carotid and middle cerebral arteries due to acute cervical dissection. The cervical lesion was completely occluded with no true lumen, and securing the true lumen proved extremely difficult. Therefore, we performed intracranial thrombectomy via the false lumen, followed by carotid artery stenting from the distal to the proximal true lumen via the false lumen. Six months later, follow-up examinations revealed no obvious complications. Our literature review identified only three reports of stenting in the false lumen of an acute carotid artery dissection, and no apparent complications were reported in any of these cases. Furthermore, the technique of recanalization through the false lumen is well established in chronic total occluded lesions of coronary or peripheral arteries when the true lumen cannot be secured. Therefore, access to the intracranial artery via the false lumen may be acceptable in situations of simultaneous intracranial arterial occlusion requiring rapid recanalization where securing a true lumen is challenging.

Keywords: acute ischemic stroke (ais); carotid stenting; false lumen; spontaneous internal carotid artery dissection; tandem lesion.