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Spontaneous internal carotid artery dissection (SICAD) has classically been associated with a good prognosis and many clinicians treat it conservatively.[1] However, a recent study reiterates the very poor recanalization rates in SICAD with complete occlusion.[2] Moreover, collateral flow is critically important in maintaining cerebral perfusion in such patients. Hence our case highlights the option of primary stenting in selected cases of SICAD with ischemic stroke, especially those with complete occlusion of the ICA and poor collateralisation. Prior case reports have shown the importance of considering primary stenting over intraarterial thrombolysis in selected cases of ischemic stroke.[3,4] Intravenous or intra-arterial thrombolysis was unlikely to have provided any benefits in this instance.

Multiple extracranial metastases from intradiploic meningioma