Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents
Authors
Ansari, S. A.Kuhn, Anna L.
Honarmand, A. R.
Khan, M.
Hurley, M. C.
Potts, M. B.
Jahromi, B. S.
Shaibani, A.
Gounis, Matthew J.
Wakhloo, Ajay K.
Puri, Ajit S.
UMass Chan Affiliations
New England Center for Stroke ResearchDepartment of Radiology, Division of Neuroimaging and Intervention
Document Type
Journal ArticlePublication Date
2017-01-11
Metadata
Show full item recordAbstract
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (>/=3 stents) and presenting with acute (<12>hours) ischemic stroke symptoms (NIHSS score, >/=4). We analyzed patient demographics, vascular risk factors, clinical presentations, imaging/angiographic findings, technical procedures/complications, and clinical outcomes. RESULTS: Fifteen patients (mean age, 51.5 years) with acute ischemic stroke (mean NIHSS score, 15) underwent endovascular stent reconstruction for vessel and/or ischemic tissue salvage. All carotid dissections presented with >70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b-3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of <20% in-stent stenosis. Early clinical improvement resulted in a mean discharge NIHSS score of 6, and 9/15 (60%) patients achieved a 90-day mRS ofSource
AJNR Am J Neuroradiol. 2017 Jan;38(1):97-104. doi: 10.3174/ajnr.A4965. Epub 2016 Nov 10. Link to article on publisher's siteDOI
10.3174/ajnr.A4965Permanent Link to this Item
http://hdl.handle.net/20.500.14038/48104PubMed ID
28059705Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.3174/ajnr.A4965