Carotid artery dissection classes: spontaneous or traumatic. Once considered uncommon, spontaneous carotid artery dissection is an increasingly recognised cause of stroke that preferentially affects the middle-aged. The incidence of spontaneous carotid artery dissection is low, and incidence rates for internal carotid artery dissection have been reported to be 2.6 to 2.9 per 100,000. Observational studies and case reports published since the early 1980s show that patients with spontaneous internal carotid artery dissection may also have a history of stroke in their family and/or hereditary connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease, pseudoxanthoma elasticum, fibromuscular dysplasia, and
Carotid stenting trial. This trial showed no difference between carotid stenting and carotid surgery in average risk patients. Most recently, a broad consensus of experts released a guideline document suggesting that in most cases, carotid stenting may be considered an alternative therapy to surgery. Carotid stenting can be performed under general or local anesthesia. Critical steps in the procedure are vascular access, crossing the stenosis with a wire, deploying a stent across the lesion, and removing the vascular access. A number of other steps may or may not be performed, including the use of a cerebral protection device, pre- or post-stent balloon