Internal carotid artery dissection with occlusion during heparin therapy

Abstract

Internal carotid artery dissection (ICAD) is frequently treated with anticoagulation. Objections against anticoagulation are based on solely theoretical concerns of progressive intramural haematoma. We describe a patient with progressive stenoocclusion of the internal carotid artery (ICA) due to intramural haematoma as a possible complication of immediate heparin treatment in ICAD. Heparin dosage was based on estimates of body weight due to aphasia. The later determined body mass index (15 kg/m2) showed that the initial dosage was 20% too high. Follow-up neurosonology disclosed haematoma-related ICA occlusion. Thus, in ICAD heparin treatment bears the risk of overanticoagulation leading to progressive mural haematoma, especially in low-weight patients.