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Interventional management for secondary intracranial extension of spontaneous cervical arterial dissection
Michelle J Smith1, Alejandro Santillan, Alan Segal
1Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
Insights
Spontaneous cervical artery dissection (sCAD) is a rare cause of stroke in young adults. Endovascular stenting may be a viable option for medically refractory cases with intracranial extension.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Spontaneous cervical artery dissection (sCAD) is a significant cause of stroke and subarachnoid hemorrhage (SAH) in young individuals.
- Current treatment primarily involves anticoagulation and antiplatelet medications, with endovascular treatment indications still under investigation.
Observation:
- Two cases of medically refractory sCAD with intracranial extension were successfully treated.
- Treatment involved the use of multiple intra- and extracranial stents.
Findings:
- Patients were followed up for 4 years and 1 year, respectively.
- Progressive sCAD with intracranial extension, despite medical therapy, is uncommon and linked to poorer outcomes.
Implications:
- The study suggests that earlier consideration of endovascular therapy might benefit select patients who do not respond to medical management.
- Advancements in interventional techniques may improve outcomes for complex sCAD cases.
Background:
Spontaneous cervical artery dissection (sCAD) is an important etiology of stroke and subarachnoid hemorrhage (SAH) in young patients. Anticoagulation and platelet antiaggregant medications are the treatment of choice, while the indications of endovascular treatment are still to be defined.
Case Description:
We report two cases of medically refractory sCAD with intracranial extension treated successfully with multiple intra and extracranial stents. The patients were evaluated at 4 years and 1-year follow-up.
Conclusion:
Progressive, spontaneous cervical artery dissection with intracranial extension despite adequate medical therapy is rare and associated with worse prognosis. Given the rapid evolution of interventional technology and techniques, if we are better able to predict the cohort of patients that fail medical management, earlier endovascular therapy may be considered.
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