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Purpose <p>Internal carotid artery dissection (ICA-D) frequently leads to ischemic stroke in individuals under 50 years. There is mounting evidence on the role of the styloid process (SP) in ICA-D, particularly SP length and the SP–ICA distance. Despite having clear guidelines on the treatment of SP-related Eagle syndrome and ICA-D, the concept of SP-related ICA-D is relatively new and no therapeutic guidelines exist.</p> Methods <p>A narrative literature search was performed to identify all articles pertaining to the diagnosis and treatment of ICA-D linked to an ipsilateral elongated SP or short SP-ICA distance. The treatments were evaluated in terms of symptom recurrence after the treatment. As illustrative examples of clinical management, we present an in-house case series of patients with suspected ICA-D related to SP.</p> Results <p>Treatment efficacy was assessed, with an in-house case series provided. Seventy-five reports and case studies involving 84 patients were analyzed. Conservative treatments were common (52%) but had a high symptom recurrence rate (33%). It is noteworthy that no patients treated initially with styloidectomy exhibited symptom recurrence.</p> Conclusion <p>In case of a correctly diagnosed SP-related ICA-D, a styloidectomy may offer a curative option, but more research is needed for clear indications and standardized guidelines to prevent recurrent symptoms or strokes.</p>

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Styloid process-related internal carotid artery dissection: extensive literature review of diagnosis, treatment and outcomes (exemplified with a single-center case series)

  • 期刊论文

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  • 发表日期：

    2025年4月26日

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  • Tomas Klail,
  • Ludwig Sachs,
  • Leonidas D. Panos,
  • Oliver Y. Urban,
  • Teresa Siller,
  • Sara Pilgram-Pastor,
  • Roland Giger,
  • Martin Müller,
  • Franca Wagner

摘要

Purpose

Internal carotid artery dissection (ICA-D) frequently leads to ischemic stroke in individuals under 50 years. There is mounting evidence on the role of the styloid process (SP) in ICA-D, particularly SP length and the SP–ICA distance. Despite having clear guidelines on the treatment of SP-related Eagle syndrome and ICA-D, the concept of SP-related ICA-D is relatively new and no therapeutic guidelines exist.

Methods

A narrative literature search was performed to identify all articles pertaining to the diagnosis and treatment of ICA-D linked to an ipsilateral elongated SP or short SP-ICA distance. The treatments were evaluated in terms of symptom recurrence after the treatment. As illustrative examples of clinical management, we present an in-house case series of patients with suspected ICA-D related to SP.

Results

Treatment efficacy was assessed, with an in-house case series provided. Seventy-five reports and case studies involving 84 patients were analyzed. Conservative treatments were common (52%) but had a high symptom recurrence rate (33%). It is noteworthy that no patients treated initially with styloidectomy exhibited symptom recurrence.

Conclusion

In case of a correctly diagnosed SP-related ICA-D, a styloidectomy may offer a curative option, but more research is needed for clear indications and standardized guidelines to prevent recurrent symptoms or strokes.