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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Treatment of Internal Carotid Artery Dissection Presenting with Acute Ischemic Stroke
Mohamed Farouk1, Kenichi Sato2, Yasushi Matsumoto2
1Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan; Department of Neurosurgery, Mansoura University Faculty of Medicine, Mansoura, Egypt.
Insights
Endovascular therapy, including stent-assisted angioplasty, shows promise for treating acute strokes caused by internal carotid artery dissection, leading to high reperfusion rates and good patient outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- The optimal treatment for strokes resulting from carotid artery dissection remains unclear.
- Establishing the most effective endovascular techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of endovascular treatment for acute ischemic strokes secondary to internal carotid artery dissection.
- To report on the procedural success and clinical outcomes in a cohort of patients.
Main Methods:
- Retrospective analysis of consecutive patients undergoing endovascular therapy for internal carotid artery dissection-related strokes (Jan 2008-July 2019).
- Patient selection based on clinical-radiologic mismatch, NIHSS score (≥5), and symptom onset within 6 hours.
- Detailed description of endovascular techniques, including stent-assisted angioplasty, and analysis of recanalization, dilatation, and clinical outcomes.
Main Results:
- Seven patients were included, with a mean age of 55; 71.4% were male.
- Successful recanalization was achieved in 85.7% of cases, with stent-assisted angioplasty being the predominant technique (85.7%).
- Mean NIHSS score improved significantly (13.7 to 5), and 85.7% of patients achieved good functional outcomes (mRS 0-2) at 3 months, with no recurrent strokes during follow-up.
Conclusions:
- Endovascular therapy for internal carotid artery dissection-related strokes demonstrates high reperfusion rates and favorable clinical outcomes.
- Stent-assisted angioplasty appears to be a safe and effective treatment modality in this patient population.
Background:
Definitive treatment of carotid dissection-related strokes is currently unproved. The best endovascular technique in this setting remains to be established.
Objective:
To report our experience in endovascular treatment of internal carotid artery dissection presenting with acute strokes.
Methods:
Consecutive patients with acute strokes due to internal carotid artery dissection treated with endovascular therapy at our hospital between January 2008 and July 2019 were included. Patients were assigned to endovascular treatment according to clinical-radiologic mismatch, NIHSS greater than or equal to 5, and within 6 hours after symptom onset. The endovascular technique is described. Intracranial recanalization, carotid dilatation, and clinical outcomes were retrospectively analyzed.
Results:
Seven patients met the inclusion criteria. The mean age was 55 years; 5 patients (71.4%) were male. 71.4% had tandem occlusion strokes, while 28.6% had hemodynamic strokes. The mean onset-to-puncture time was 3.92 hours. Stent-assisted angioplasty for internal carotid artery was done for 85.7% of patients with a mean of 1.6 deployed stents. Dilatation was successful in 83.3% of them. Successful overall recanalization rate was 85.7%. No major complications were encountered. Minor complications occurred in 42.8% of cases. The mean NIHSS score decreased from 13.7 preoperative to 5 after 3 days. Good functional outcome (mRS 0-2) was found in 85.7% of patients at 3 months. No recurrent strokes identified over an average of 40.86 months follow-up.
Conclusion:
Our study provides evidence that endovascular therapy for internal carotid artery dissection-related strokes has high rates of reperfusion and favorable outcomes. Stent-assisted angioplasty of carotid dissection is thought to be safe and effective.
