Endovascular stenting of extracranial cervical artery dissections: A two-center study

Extracranial arterial dissections (EAD) are uncommon in the general population but represent a relatively frequent cause of ischemic stroke in young adults. Most EAD have a favorable prognosis and are managed conservatively with antithrombotic therapy, with current guidelines supporting either antiplatelet or anticoagulant treatment. Endovascular stenting is reserved for selected high-risk cases, and this article reports a multicenter experience with this approach and reviews the available literature.

Eighty-four EAD patients who underwent stenting were included. A standardized follow-up protocol at 12 months consisting of a clinical neurological assessment accompanied by imaging studies, including either Computed Tomography, Magnetic Resonance Imaging or Digital Subtraction Angiography was adopted.

In our cohort, most dissections were spontaneous (81 %) and predominantly involved the internal carotid artery (85 %), with acute stroke being the most common indication for stenting. Technical success was achieved in 85.7 % and complications occurred in 10 %. Three patients with initial stent implantation failure underwent successful secondary attempt. No significant predictors of technical success were identified. At discharge, good functional outcome was observed in 83 % of patients and at 12 months most followed patients showed favorable radiological results with high stent patency (86 %) and excellent clinical outcomes (mRS 0-2 in 97 %).

The results of our study suggest that for selected patients with medical therapy failure or hemodynamic compromise, stenting is a reasonable alternative. Given the limited evidence on indications, safety and efficacy, further randomized studies comparing stenting with medical management are warranted.