Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular disease management
• Interventional neuroradiology

Background:

• Endovascular treatment for internal carotid artery (ICA) dissection with tandem intracranial occlusion is an evolving field.
• Complex ICA anatomy, such as 360° tonsillar loops, presents unique challenges.
• Traditional treatments may be insufficient for these complex dissections.

Purpose of the Study:

• To report the feasibility and outcomes of stent reconstruction for internal carotid artery dissections with tandem intracranial occlusions.
• To evaluate a novel endovascular approach for complex cerebrovascular anatomy.
• To demonstrate the utility of stent technology in managing challenging ICA dissections.

Main Methods:

• Two patients with symptomatic ICA dissections and tandem intracranial occlusions underwent endovascular treatment.
• Manual aspiration thrombectomy (MAT) was used for reperfusion.
• Telescoping Zilver self-expanding peripheral stents were employed for reconstruction of the dissected carotid loop.
• Patient data, techniques, and outcomes were retrospectively reviewed.

Main Results:

• Successful reperfusion (modified Treatment in Cerebral Ischemia scale 2B) was achieved in both cases using MAT.
• Complete endovascular reconstruction of the dissected extracranial ICA loop was accomplished with stenting.
• Significant improvement in neurological status was observed, with National Institutes of Health Stroke Scale scores decreasing from 16 to 0 and 14 to 0.
• Both patients achieved a modified Rankin scale score of 1 at 3-month follow-up, indicating good functional recovery.

Conclusions:

• Stent reconstruction is a feasible endovascular technique for complex cerebrovascular anatomy, including ICA dissections with tandem occlusions.
• Advancements in stent technology and catheter support systems enhance the ability to treat variant ICA anatomy.
• This approach offers a valuable option for neuroendovascular surgeons managing challenging dissection cases.