Bilateral carotid dissections after a dental procedure: the role of stenting in unstable lesions.

Cervical dissections are a rare but potentionally devastating complication of positioning in anesthetized patients. A 40-year-old woman was noted to have right arm weakness after a prolonged dental procedure. Imaging revealed bilateral carotid dissections with severe stenosis. The patient had further clinical deterioration despite therapeutic anticoagulation. Carotid stenting of the symptomatic left carotid artery led to improved flow and the patient had no further events. Caution should be exercised during prolonged neck hyperextension to avoid the potentially devastating complication of cervical dissection. Carotid stenting may be necessary to maintain adequate flow in patients with clinical instability despite medical therapy.