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Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience
Hajime Ohta1, Sabareesh K Natarajan, Erik F Hauck
1Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
Insights
Endovascular stent therapy for carotid artery dissections (CADs) proved safe and effective, achieving high recanalization rates and favorable outcomes in most patients. Selected patients, especially those with symptomatic CADs unresponsive to medical therapy, can benefit from this intervention.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- Carotid artery dissections (CADs) are a significant cause of stroke, particularly in younger populations.
- Traditional management often involves anticoagulation, but endovascular approaches are emerging for complex cases.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular stent therapy for both extra- and intracranial carotid artery dissections (CADs).
Main Methods:
- Retrospective review of 44 CAD cases treated with carotid artery (CA) stent placement between 2000 and 2009.
- Analysis included lesion characteristics, procedural success, complications, and clinical outcomes using modified Rankin Scale (mRS) and NIH Stroke Scale.
Main Results:
- Successful stent deployment in 97.7% of cases, with 95.5% recanalization rates.
- Favorable outcomes (mRS 0-2) at discharge in 83.7% of patients.
- Low rate of permanent deficits (2.3%) and no new strokes during follow-up (mean 19.2 months).
Conclusions:
- Endovascular stent-assisted repair is a safe and effective treatment for selected extra- and intracranial CADs.
- Recommended for symptomatic CADs refractory to medical management.
- High rate of permanent dissection resolution (90.5%) observed in angiographic follow-up.
Object:
The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs).
Methods:
Retrospective review of data at Millard Fillmore Gates Hospital identified 43 patients with 44 CADs (intracranial and/or extracranial) treated with carotid artery (CA) stent placement between January 2000 and June 2009.
Results:
Thirty-two CADs were spontaneous and 12 were traumatic; 35 were symptomatic. Lesion locations included the extracranial internal CA (ICA; 24 cases), extracranial ICA with common CA involvement (4 cases), and extracranial ICA-intracranial ICA (16 cases). Carotid artery occlusion was 100% in 15 cases (34.1%), 99% in 6 cases (13.6%), 70%-98% in 13 cases (29.5%), and < 70% in 10 cases (22.7%). Five patients suffered pseudoaneurysms. Stent deployment was successful in 43 (97.7%) of 44 cases. The mean pretreatment score on the National Institutes of Health Stroke Scale was 6.2 ± 6.2. Recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3) was accomplished for 42 lesions (95.5%). Four patients demonstrated residual parent vessel stenosis (10%-50% in severity). Procedure-related complications occurred in 7 patients and included middle cerebral artery embolism (1 patient), intracranial hemorrhage (2 patients), worsening of dissection (1 patient), stent malpositioning (1 patient), embolic protection filter overload (1 patient), and filter retrieval device fracture (1 patient). Only 2 of these complications caused permanent deficits: the embolism caused a minor but permanent neurological deficit, and 1 intracranial hemorrhage was fatal. At discharge, 36 patients (83.7%) had modified Rankin Scale scores of 0-2 (favorable outcome). During the follow-up interval (mean 19.2 months, range 4-92 months), no patient suffered a new stroke and 1 patient died secondary to preexisting chronic renal failure. In 20 patients with angiographic follow-up, permanent resolution of the dissection was noted in 90.5%; 2 lesions (9.5%) required retreatment.
Conclusions:
Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.