Nineteen reports of pediatric cases of extracranial traumatic carotid artery dissection (CAD), obtained through PubMed search, were reviewed by researchers at Texas Children’s Hospital and Baylor College of Medicine, Houston, TX. Diagnosis made after onset of ischemic symptoms was confirmed by cerebral angiography in 24 of 34 patients, and reconfirmed by MR angiography in 6 patients; CA Doppler scanning was used alone in 4 patients. Thirty patients were treated with medical therapy or observation. Open surgical or endovascular treatment of CAD was rarely employed in the pediatric population. Of 17 patients treated conservatively with anticoagulation/antiplatelet therapy, 4 recovered completely, and 11 were partially recovered. Of 12 patients treated expectantly without anticoagulation, 2 recovered completely, 8 recovered partially, and 2 died. Of 4 patients treated surgically, 3 showed partial improvement, and 1 died 5 days postoperatively. The authors favor MR angiography as a screening test, anti-platelet therapy to anticoagulation therapy as first-line medical treatment, and endovascular stenting over open surgery in cases of failed medical treatment. [1]

COMMENT. An algorithm for the evaluation and treatment of traumatic extracranial carotid artery dissection is proposed, based on a review of the literature. Arterial dissection is identified as the fourth most common cause of arterial ischemic stroke in children, after sickle cell disease, cardiac embolism, and moyamoya disease.