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Carotid dissection: technical factors affecting endovascular therapy.
Felipe C Albuquerque1, Patrick P Han, Robert F Spetzler
1Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.
Summary
Endovascular treatment, including angioplasty and stenting, is a safe option for managing carotid dissections. Factors like pseudoaneurysms or tortuous anatomy can affect success, while dissections from endarterectomy may need repeat procedures.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- Extracranial carotid dissections present a significant challenge in vascular management.
- Identifying factors influencing successful treatment is crucial for patient outcomes.
Purpose of the Study:
- To delineate factors associated with successful endovascular treatment of extracranial carotid dissections.
- To review the management and outcomes of 13 cases of extracranial carotid dissection.
Main Methods:
- Retrospective review of 12 patients (13 dissections) undergoing endovascular treatment.
- Assessment of dissection mechanism, symptoms, pseudoaneurysm presence, and treatment outcomes.
- Prospective follow-up to evaluate patency and complications.
Main Results:
- Successful angioplasty and stenting in 11 of 13 procedures (10 of 12 patients).
- Excellent patency observed in 9 of 11 treated vessels post-procedure.
- Pseudoaneurysms resolved in all four cases treated with stenting; no permanent complications occurred.
Conclusions:
- Endovascular treatment (angioplasty and stenting) is a safe and effective option for carotid dissection.
- Pseudoaneurysms and tortuous anatomy can be challenges but often resolve with stenting.
- Dissections secondary to endarterectomy may have increased restenosis risk, potentially requiring further intervention.