Ischemic stroke caused by spontaneous anterior circulation intracranial arterial dissections: patient series
Insights
Intracranial arterial dissections (IADs) in the anterior circulation are a rare cause of stroke. This study shows a proposed treatment algorithm for spontaneous IAD resulted in positive outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Neuroradiology
Background:
- Intracranial arterial dissections (IADs) are a significant cause of ischemic stroke, particularly in the anterior circulation.
- Literature on the surgical management of anterior circulation IAD is limited.
- This study retrospectively analyzes 9 patients with spontaneous anterior circulation IAD.
Purpose of the Study:
- To present data on the diagnosis and management of anterior circulation IAD.
- To evaluate the outcomes of endovascular and medical management for these dissections.
- To propose a treatment algorithm for spontaneous anterior circulation IAD.
Main Methods:
- Retrospective collection of data from 9 patients with spontaneous anterior circulation IAD (2019-2021).
- Patients were managed with emergent endovascular intervention (stenting or thrombectomy) or medically.
- Follow-up angiography assessed for reocclusion, guiding therapy like glycoprotein IIb/IIIa inhibitors and stenting.
Main Results:
- Seven patients underwent endovascular intervention; two were managed medically.
- Two patients required further intervention for stenosis; two developed asymptomatic stenosis/occlusion with good collateralization.
- Most patients demonstrated patent vasculature on follow-up imaging, with seven achieving a modified Rankin Scale score of ≤1 at 3 months.
Conclusions:
- Spontaneous anterior circulation IAD is a rare but devastating cause of ischemic stroke.
- The proposed treatment algorithm led to favorable clinical and angiographic outcomes.
- Further study is warranted to validate this approach in emergent management.
Background:
Intracranial arterial dissections (IADs) are classically associated with the vertebrobasilar system, yet are a devastating cause of ischemic stroke within the anterior circulation. Current literature regarding the surgical management of anterior circulation IAD is lacking. As a result, data on 9 patients presenting with ischemic stroke due to spontaneous anterior circulation IAD between 2019 and 2021 were collected in a retrospective manner. Symptoms, diagnostic modalities, treatment, and outcomes are presented for each case. Patients who underwent endovascular procedures had 10-minute follow-up angiography performed to identify signs of reocclusion, which prompted initiation of glycoprotein IIb/IIIa therapy and stent placement.
Observations:
Seven patients underwent emergent endovascular intervention (stenting: n = 5; thrombectomy alone: n = 2). The remaining 2 were managed medically. Two patients developed progressive flow limiting stenosis requiring further intervention, 2 developed asymptomatic progressive stenosis/occlusion with robust collateral formation and the remainder have patent vasculature upon follow up imaging at 6 to 12 months. Seven patients had a modified Rankin Scale score of 1 or less at the 3-month follow-up.
Lessons:
IAD is a devastating yet rare cause of anterior circulation ischemic stroke. The treatment algorithm proposed resulted in positive clinical and angiographic outcomes warranting future consideration and study in the emergent management of spontaneous anterior circulation IAD.
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