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Extracranial Internal Carotid Artery Dissection Treated with Self-expandable Stents: A Single-Centre Experience
Robert Juszkat1,2, Włodzimierz Liebert3, Katarzyna Stanisławska4,5
1Department of General and Interventional Radiology, Poznań University of Medical Sciences, 1/2 Długa St., 61-848, Poznan, Poland. robertju@wp.pl.
Insights
Carotid artery stenting is a safe and effective treatment for selected patients with internal carotid artery dissection (ICAD). This endovascular procedure restores blood flow and leads to significant clinical improvement, offering a promising alternative to anticoagulation.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- Internal carotid artery dissection (ICAD) is typically treated with anticoagulation for 3-6 months.
- Endovascular procedures are an alternative for patients with hemodynamic impairment, recurrent ischemic symptoms, or pseudoaneurysms.
Purpose of the Study:
- To evaluate the efficacy and safety of carotid artery stenting for treating selected patients with extracranial ICAD.
Main Methods:
- 18 symptomatic patients with ICAD underwent treatment with self-expandable stents.
- Follow-up included physical examination, cerebral angiography at 6 months, and clinical evaluations with duplex Doppler ultrasonography every 6 months.
Main Results:
- No deaths or life-threatening adverse events occurred during the median 21-month follow-up.
- Stent deployment restored true lumen flow in all cases; one patient had residual false lumen flow.
- Complete symptom resolution occurred in 78% of patients, with partial improvement in 11% and persistent deficits in 11%.
Conclusions:
- Self-expandable stent implantation is a safe treatment for selected extracranial ICAD cases.
- This method restores arterial blood flow in the internal carotid artery, often permanently.
- Carotid artery stenting leads to significant clinical improvement in the long term.
Purpose:
Treatment of choice for the internal carotid artery dissection (ICAD) is anticoagulation for three to 6 months. Endovascular procedures may be a promising alternative for patients (pts) with haemodynamic impairment, recurrent ischaemic symptoms or symptomatic pseudoaneurysms. Thus, the purpose of this study was to evaluate the efficacy and safety of carotid artery stenting in treatment of selected pts with extracranial ICAD.
Methods:
This study involved 18 symptomatic pts with the mean age of 44.6 ± 10.4 years with ICAD treated with the use of self-expandable stents. Six months after primary procedures, pts were readmitted to hospital and physical examination followed by cerebral angiography was performed. In the late follow-up period, clinical evaluations completed by duplex Doppler ultrasonography were carried out every 6 months and at the end of the follow-up period.
Results:
Nobody died and no life-threatening adverse events were observed during either the in-hospital stay or post-discharge follow-up period (median 21 months). Stent deployment immediately restored flow in the true lumen of ICA in all cases. However, residual blood flow through the false lumen was observed in one pt. Complete resolution of clinical symptoms was observed in 14 pts (78%), partial improvement in 2 (11%) and persistence of neurological deficit in 2 (11%).
Conclusions:
Implantation of self-expandable stents in treatment of selected extracranial ICAD cases is safe. This method may enable us to restore immediately and usually permanently proper arterial blood flow in the ICA and in consequence lead to significant clinical improvement in the late follow-up period.
