Endovascular Stenting for Symptomatic Carotid Dissection with Hemodynamic Insufficiency

• Published in: World neurosurgery 2017-06, Vol.102, p.598-607
• Main Authors: KIM, Youngsoo, M.D., Ph.D, Choi, Chang Hwa, M.D., Ph.D, Lee, Tae Hong, M.D., Ph.D, Cho, Han Jin, M.D, Sung, Sang Min, M.D., Ph.D, Baik, Seung Kug, M.D., Ph.D, Ko, Jun Kyeung, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - physiopathology; Aneurysm, Dissecting - surgery; Angioplasty; Carotid artery; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - physiopathology; Carotid Artery Diseases - surgery; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - physiology; Carotid Artery, Common - surgery; Carotid Artery, Internal - physiopathology; Carotid Artery, Internal - surgery; Cerebral Angiography - methods; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - physiopathology; Cerebral Infarction - surgery; Dissection; Endovascular Procedures - methods; Female; Follow-Up Studies; Hemodynamics - physiology; Humans; Male; Middle Aged; Neurosurgery; Stents; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.03.086

Abstract Objective To date, no controlled studies on the treatment of carotid artery dissection (CAD) have been reported. The purpose of this study was to demonstrate the technical feasibility and clinical efficacy of stent-supported angioplasty (SSA) as primary treatment for acute stroke due to CAD. Methods Review of medical records identified 21 patients who underwent SSA as primary treatment for acute stroke related to CAD between 2008 and 2014. The inclusion criteria were recent transient ischemic attack (TIA; n=7, 33.3%) or acute infarct (n=14, 66.7%) due to CAD (≥70% narrowing) with hemodynamic impairment. Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively. Results SSA was technically successful in all patients. Of 21 patients, 8 (38.1%) showed an additional intracranial occlusion and intracranial recanalization to a TICI ≥2b flow was achieved in 50.0% of the cases. Procedure-related mortality was 4.8% and morbidity was 9.5%. Five (35.7%) of 14 patients presenting with an acute infarct showed significant improvement (decrease in NIHSS score of ≥4 points compared with admission score) at seven days after SSA. During the observation period (mean, 20.5 months), stroke recurrence occurred in only one patient (5.0%), resulting in an annual stroke risk of 2.9%. A favorable outcome (modified Rankin Score [mRS] ≤2) was achieved in all 7 patients with a TIA (100.0%) and in 7 of 14 patients with an acute infarct (50.0%) at 90 days follow-up. Conclusion Our results provide evidence that SSA is a feasible and effective strategy as primary treatment for steno-occlusive CAD patients with significant hypoperfusion or a large penumbra.