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Clinical Neuroradiology

, Volume 29, Issue 4, pp 707–715 | Cite as

Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report

  • Christopher Alan HilditchEmail author
  • Waleed Brinjikji
  • Joanna Schaafsma
  • Chun On Anderson Tsang
  • Patrick Nicholson
  • Ronit Agid
  • Timo Krings
  • Vitor M Pereira
Original Article

Abstract

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.

Results

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.

Conclusion

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.

Keywords

Flow-diverter stent Stroke Carotid dissection 

Notes

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.

Ethical standards

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.

References

  1. 1.
    CADISS trial investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14:361–7.CrossRefGoogle Scholar
  2. 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
  3. 3.
    Krings T, Choi IS. The many faces of intracranial arterial dissections. Interv Neuroradiol. 2010;16:151–60.CrossRefGoogle Scholar
  4. 4.
    Kadkhodayan Y, Jeck DT, Moran CJ, Derdeyn CP, Cross DT 3rd. Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol. 2005;26:2328–35.PubMedGoogle Scholar
  5. 5.
    Robertson JJ, Koyfman A. Cervical artery dissections: a review. J Emerg Med. 2016;51(5):508–18.CrossRefGoogle Scholar
  6. 6.
    Donas KP, Mayer D, Guber I, Baumgartner R, Genoni M, Lachat M. Endovascular repair of extracranial carotid artery dissection: current status and level of evidence. J Vasc Interv Radiol. 2008;19:1693–8.CrossRefGoogle Scholar
  7. 7.
    Ahlhelm F, Benz RM, Ulmer S, Lyrer P, Stippich C, Engelter S. Endovascular treatment of cervical artery dissection: ten case reports and review of the literature. Interv Neurol. 2013;1:143–50.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017;59:641-7.CrossRefGoogle Scholar
  9. 9.
    Brzezicki G, Rivet DJ, Reavey-Cantwell J. Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series. J Neurointerv Surg. 2016;8:722–8.CrossRefGoogle Scholar
  10. 10.
    Tsang AC, Leung KM, Lee R, Lui WM, Leung GK. Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device. J Neurointerv Surg. 2015;7:603–7.CrossRefGoogle Scholar
  11. 11.
    Fischer S, Perez MA, Kurre W, Albes G, Bäzner H, Henkes H. Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms: initial experience and long-term follow-up. Neurosurgery. 2014;75:364–74.CrossRefGoogle Scholar
  12. 12.
    Amuluru K, Al-Mufti F, Roth W, Prestigiacomo CJ, Gandhi CD. Anchoring pipeline flow diverter construct in the treatment of traumatic distal cervical carotid artery injury. Interv Neurol. 2017;6:153–62.CrossRefGoogle Scholar
  13. 13.
    Kurre W, Bansemir K, Aguilar Pérez M, Martinez Moreno R, Schmid E, Bäzner H, Henkes H. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology. 2016;58:1167–79.CrossRefGoogle Scholar
  14. 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
  15. 15.
    Biousse V, D’Anglejan-Chatillon J, Touboul PJ, Amarenco P, Bousser MG. Time course of symptoms in extracranial carotid artery dissections : a series of 80 patients. Stroke. 1995;26:235–9.CrossRefGoogle Scholar
  16. 16.
    Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW; Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutic trial? Stroke. 2003;34:2856–60.CrossRefGoogle Scholar
  17. 17.
    Beletsky V, Norris JW. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;345:467.PubMedGoogle Scholar
  18. 18.
    Müller BT, Luther B, Hort W, Neumann-Haefelin T, Aulich A, Sandmann W. Surgical treatment of 50 carotid dissections: Indications and results. J Vasc Surg. 2000;31:980–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christopher Alan Hilditch
    • 1
    Email author
  • Waleed Brinjikji
    • 1
  • Joanna Schaafsma
    • 2
  • Chun On Anderson Tsang
    • 1
  • Patrick Nicholson
    • 1
  • Ronit Agid
    • 1
  • Timo Krings
    • 1
    • 3
  • Vitor M Pereira
    • 1
    • 3
  1. 1.Division of Neuroradiology, Joint Division of Medical Imaging, University Health NetworkUniversity of TorontoTorontoCanada
  2. 2.Division of NeurologyToronto Western HospitalTorontoCanada
  3. 3.Division of Neurosurgery, Department of Surgery, University Health NetworkUniversity of TorontoTorontoCanada

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