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Emergency stenting for acute symptomatic carotid stenosis: dissecting the evidence
  1. David J Werring1,
  2. Fergus J Robertson2
  1. 1Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
  2. 2Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr David J Werring, Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Box 6, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; d.werring{at}ucl.ac.uk

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Most neurologists, vascular neuroradiologists and stroke physicians encounter carotid artery dissection regularly, yet its management remains challenging. The main goal is the prevention of ischaemic stroke in the territory of the affected artery. Such strokes usually result from thromboembolism, though they can also occur due to critically reduced flow in the dissected arterial segment, a so-called haemodynamic stroke. Unfortunately, we do not have randomised controlled trial evidence for the optimal medical treatment of extracranial arterial dissection: antiplatelet agents or anticoagulants are considered reasonable options.1

Why is carotid dissection still a treatment challenge? First, like stroke itself, carotid dissection is not one disease. The aetiology (traumatic versus spontaneous), site of dissection (intracranial versus extracranial), degree of luminal stenosis and extent of intracranial collateral circulation all vary from patient to patient, with profound effects on the risk, distribution and extent of any resultant cerebral infarction. Second, although carotid artery dissection accounts for about 20% of …

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