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

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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.

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Authors and Affiliations

  1. Division of Neuroradiology, Joint Division of Medical Imaging, University Health Network, University of Toronto, 399 Bathurst St, ON M5T 2S8, Toronto, Canada

    Christopher Alan Hilditch, Waleed Brinjikji, Chun On Anderson Tsang, Patrick Nicholson, Ronit Agid, Timo Krings & Vitor M Pereira

  2. Division of Neurology, Toronto Western Hospital, Toronto, Canada

    Joanna Schaafsma

  3. Division of Neurosurgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    Timo Krings & Vitor M Pereira

Authors
  1. Christopher Alan Hilditch
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  2. Waleed Brinjikji
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  3. Joanna Schaafsma
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  4. Chun On Anderson Tsang
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  5. Patrick Nicholson
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  6. Ronit Agid
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  7. Timo Krings
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  8. Vitor M Pereira
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Corresponding author

Correspondence to Christopher Alan Hilditch.

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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.

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Contributorship Statement

CH, WB, JS, CAT, PN, RA, TK and VMP made (1) substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data for the work and (2) drafting of the work or revising it critically for important intellectual content and (3) final approval of the version to be published and are in (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Data Sharing Statement

Data could be made available by contacting the corresponding author via email.

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Hilditch, C.A., Brinjikji, W., Schaafsma, J. et al. Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report. Clin Neuroradiol 29, 707–715 (2019). https://doi.org/10.1007/s00062-018-0707-z

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  • DOI: https://doi.org/10.1007/s00062-018-0707-z

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