Feasibility and safety of stenting for symptomatic carotid arterial dissection
1Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Insights
Carotid angioplasty and stenting proved feasible and safe for patients with carotid artery dissection (CAD) unresponsive to antithrombotic therapy. This endovascular approach offers a viable treatment option for complex cases.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Carotid artery dissection (CAD) is a significant cause of stroke in younger adults.
- Failure of antithrombotic therapy in acute CAD necessitates alternative treatment strategies.
- Symptomatic CAD (sCAD) poses a risk of ischemic events.
Purpose of the Study:
- To evaluate the procedural feasibility and safety of carotid angioplasty and stenting.
- To assess the efficacy of endovascular treatment in patients with CAD who failed medical management.
- To determine the outcomes of stenting in acute carotid artery dissection.
Main Methods:
- Retrospective review of 33 consecutive patients with sCAD treated between May 2005 and December 2010.
- Diagnosis confirmed by catheter angiography; patients had failed initial antithrombotic therapy.
- Analysis of baseline and follow-up data including technical success and complications.
Main Results:
- Technical success achieved in 32 out of 33 patients (97%) with no intraoperative complications.
- Two patients (6%) developed ipsilateral Horner sign post-procedure.
- One patient experienced a transient ischemic attack (TIA) recurrence during follow-up, successfully managed with antithrombotics.
Conclusions:
- Endovascular stenting is a feasible and safe therapeutic option for CAD patients.
- Angioplasty and stenting provide a successful alternative when antithrombotic therapy fails.
- This interventional strategy demonstrates good outcomes in managing complex carotid artery dissections.
Objective:
To determine the procedural feasibility and safety of carotid angioplasty and stent placement of carotid artery dissection (CAD) patients who had failed antithrombotic therapy in acute dissection.
Methods:
A series of 33 consecutive patients (mean age, 40.21 years; 29 men and 4 women) who underwent angioplasty and stent placement for symptomatic carotid artery dissection (sCAD) from May 2005 to December 2010 in the Nanjing Stroke Registry Program (NSRP) was retrospectively reviewed. All the included patients had been diagnosed definitively based on catheter angiography, and had failed to respond to medical therapy during the course of initial hospital admission. The baseline and followed up data of these patients were collected and analyzed.
Results:
Of all the 33 included patients, 32 patients had achieved technical success without any intraoperative complications. Two patients manifested ipsilateral Horner sign on the next day after stenting, and one of them suffered from recurrence of transient ischaemic attack (TIA) during the course of follow up, but completely remission via antithrombotic therapy.
Conclusion:
Endovascular stenting is a feasible and safe therapeutic strategy of CAD patients who have failed medical therapy.
