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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.7K

Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic

S A Ansari1, A L Kühn2, A R Honarmand3

  • 1From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois s-ansari@northwestern.edu.

AJNR. American Journal of Neuroradiology
|January 7, 2017
PubMed

Insights

Emergent endovascular stenting effectively treats long-segment carotid dissections in acute ischemic stroke patients. This intervention restores blood flow, aids thrombectomy, and improves clinical outcomes, demonstrating safety and efficacy.

Area of Science:

  • Neuroendovascular intervention
  • Cerebrovascular disease management
  • Acute ischemic stroke treatment

Background:

  • Most cervical dissections are managed medically.
  • Emergent endovascular treatment is crucial for specific cases like large-vessel occlusions, flow-limiting dissections, or impending occlusion.
  • Hypoperfusion-related ischemia at risk of infarction necessitates prompt intervention.

Purpose of the Study:

  • To investigate the role and efficacy of emergent endovascular stenting.
  • Focus on long-segment carotid dissections within the acute ischemic stroke setting.
  • Evaluate outcomes of stent reconstruction for vessel and ischemic tissue salvage.

Main Methods:

  • Retrospective study of 15 patients with long-segment carotid dissections.
  • Patients presented with acute ischemic stroke symptoms (<12 hours) and required multiple tandem stents (≥3).
  • Analysis included demographics, risk factors, clinical presentation, imaging, procedures, complications, and outcomes.

Main Results:

  • Successful stent reconstruction in all 15 patients with no residual stenosis or flow limitation.
  • Nine patients (60%) had intracranial occlusions; 6 (40%) underwent successful intra-arterial thrombolysis/thrombectomy (100% TICI 2b-3 reperfusion).
  • Low morbidity (7%) and zero mortality, with favorable clinical improvement (mean discharge NIHSS 6) and 90-day mRS ≤2 in 60%.

Conclusions:

  • Emergent stent reconstruction is safe and effective for long-segment, flow-limiting carotid dissections in acute ischemic stroke.
  • The procedure facilitates successful thrombectomy, vessel salvage, and restores cerebral perfusion.
  • It serves as a viable strategy to prevent recurrent thromboembolic stroke with favorable clinical outcomes.
Abstract

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