Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report
- 148 Downloads
Background and Purpose
Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management.
Materials and Methods
Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates.
A total of 7 patients were included. The mean age was 47 years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events.
Reconstruction of the ICA as a rescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series.
KeywordsFlow-diverter stent Stroke Carotid dissection
Compliance with ethical guidelines
Conflict of interest
C.A. Hilditch, W. Brinjikji, J. Schaafsma, C.O. Anderson Tsang, P. Nicholson, R. TAgid. Krings and V.M. Pereira declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- 2.Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, Ayrignac X, Bonafé A, Costalat V. Endovascular management of tandem occlusion stroke related to internal carotid artery dissection using a distal to proximal approach: insight from the RECOST study. AJNR Am J Neuroradiol. 2016;37:1281–8.CrossRefGoogle Scholar
- 14.Lavallée PC, Mazighi M, Saint-Maurice JP, Meseguer E, Abboud H, Klein IF, Houdart E, Amarenco P. Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion. Stroke. 2007;38:2270–4.CrossRefGoogle Scholar