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Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet.

Methods

From an institutional database, we retrospectively selected consecutive patients treated for a-ICAD between January 2007 and July 2015. We assessed recanalization results defining <50 % residual stenosis and mTICI ≥2b as successful. Procedural adverse events and symptomatic haemorrhages were reported as well as clinical outcome at 90 days defining a mRS ≤2 as favourable. Follow-up angiographies were reviewed and retreatments reported.

Results

In the defined period, 73 patients (mean age 48 years (31–73), mean NIHSS 11 (0–27)) received EVT for a-ICAD. The majority (60 %) had tandem occlusions. Cervical artery reconstruction was successful in 100 % and intracranial thrombectomy in 85 %. Thrombus formation (18 %) and thromboembolism (20 %) were the most frequent adverse events but clinically relevant only in 8 %. Symptomatic haemorrhage occurred in 5 %. Clinical outcome was favourable in 64 %, with a lower chance after tandem occlusion (55 vs. 79 %, p = 0.047). Death rate was 10 %. None of the patients developed recurrent ischaemic symptoms, but control angiography revealed abnormal findings of the reconstructed ICA in 38 % leading to retreatment in 17 %.

Conclusion

EVT of a-ICAD is feasible with a predominantly favourable clinical outcome. Improvement of devices and techniques is warranted to reduce the risk of thrombus formation and thromboembolism during treatment and insufficient vessel wall healing thereafter.

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Acknowledgments

We thank Casjupea Knispel for support in data acquisition, Hiltrud Niggemann for statistical analysis, Timo Steinmetz for data review and James Lago for language revision.

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Authors and Affiliations

  1. Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    Wiebke Kurre, Kai Bansemir, Marta Aguilar Pérez, Rosa Martinez Moreno & Hans Henkes

  2. Institut für Neuroradiologie, Universitätsklinik Frankfurt, Goethe-Universität, Frankfurt, Germany

    Wiebke Kurre

  3. Klinik für Neurochirurgie, Klinikum Kempten, Kempten, Germany

    Kai Bansemir

  4. Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany

    Elisabeth Schmid & Hansjörg Bäzner

  5. Medizinische Fakultät, Universitätsklinik Duisburg-Essen, Essen, Germany

    Hans Henkes

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  1. Wiebke Kurre
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Corresponding author

Correspondence to Wiebke Kurre.

Ethics declarations

We declare that all human and animal studies have been approved by the ethics committee of Baden Württemberg and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

WK has a consulting agreement with phenox; MA-P proctors for phenox; HB receives lecture honorarium from Boehringer Ingelheim, Bayer Vital, Daiichi Sankyo and Bristol-Myers Squibb; and HH proctors for Covidien/Medtronic and is cofounder/shareholder/board member and proctor for phenox.

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Kurre, W., Bansemir, K., Aguilar Pérez, M. et al. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology 58, 1167–1179 (2016). https://doi.org/10.1007/s00234-016-1757-z

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  • DOI: https://doi.org/10.1007/s00234-016-1757-z

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