Stent placement for the treatment of a symptomatic intracranial arterial dissection in an adolescent

Case report

View More View Less
  • 1 Department of Neurosurgery,
  • 2 Toshiba Stroke Research Center, and
  • 3 Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
  • 4 Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Intracranial arterial dissection is an important cause of stroke in young patients. Treatment options include observation, antiplatelet or anticoagulation regimens, and endovascular stent placement. The authors describe the case of a 14-year-old boy who presented with a symptomatic, posttraumatic dissection extending from the intracranial internal carotid artery to the middle cerebral artery. Images obtained approximately 48 hours after this incident revealed a subacute right frontal lobe infarct, and a CT stroke study (CT angiography and CT perfusion) confirmed the vascular injury and associated decreased perfusion, prompting revascularization with a self-expanding stent. The patient did well clinically after stent placement and showed no evidence of restenosis on follow-up angiography 3 and 6 months later. This report is, to the authors' knowledge, the first description of the use of a stent for a symptomatic intracranial dissection in an adolescent.

Abbreviations used in this paper: DS = digital subtraction; ICA = internal carotid artery; MCA = middle cerebral artery; TTP = time to peak.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Elad I. Levy, M.D., University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Gates Circle, Buffalo, New York 14209. email: elevy@ubns.com.
  • 1

    Carolei A, , Marini C, , Di Napoli M, , Di Gianfilippo G, , Santalucia P, & Baldassarre M, : High stroke incidence in the prospective community-based L'Aquila registry (1994-1998). First year's results. Stroke 28:25002506, 1997

    • Search Google Scholar
    • Export Citation
  • 2

    Chabrier S, , Lasjaunias P, , Husson B, , Landrieu P, & Tardieu M: Ischaemic stroke from dissection of the craniocervical arteries in childhood: report of 12 patients. Eur J Paediatr Neurol 7:3942, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Chamoun RB, , Mawad ME, , Whitehead WE, , Luerssen TG, & Jea A: Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options. J Neurosurg Pediatr 2:101108, 2008

    • Search Google Scholar
    • Export Citation
  • 4

    Chaves C, , Estol C, , Esnaola MM, , Gorson K, , O'Donoghue M, & De Witt LD, : Spontaneous intracranial internal carotid artery dissection: report of 10 patients. Arch Neurol 59:977981, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Dorros G, , Cohn JM, & Palmer LE: Stent deployment resolves a petrous carotid artery angioplasty dissection. AJNR Am J Neuroradiol 19:392394, 1998

    • Search Google Scholar
    • Export Citation
  • 6

    Ecker RD, , Levy EI, & Hopkins LN: Acute neuroform stenting of a symptomatic petrous dissection. J Invasive Cardiol 19:E137E138, 2007

  • 7

    Fullerton HJ, , Johnston SC, & Smith WS: Arterial dissection and stroke in children. Neurology 57:11551160, 2001

  • 8

    Higashida RT, , Halbach VV, , Dowd CF, , Juravsky L, & Meagher S: Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26:17511756, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Jensen MB, , Chacon MR, & Aleu A: Cervicocerebral arterial dissection. Neurologist 14:56, 2008

  • 10

    Levy E, , Horowitz M, , Jovin T, & Kassam A: Successful management of post-tumor resection middle cerebral artery thrombosis with stent-assisted angioplasty and thrombolytic therapy: case report. Neurosurgery 55:713, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    Levy EI, , Mehta R, , Gupta R, , Hanel RA, , Chamczuk AJ, & Fiorella D, : Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol 28:816822, 2007

    • Search Google Scholar
    • Export Citation
  • 12

    Levy EI, , Siddiqui AH, , Crumlish A, , Snyder KV, , Hauck EF, & Fiorella DJ, : First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke 40:35523556, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Nagumo K, , Nakamori A, & Kojima S: [Spontaneous intracranial internal carotid artery dissection: 6 case reports and a review of 39 cases in the literature.]. Rinsho Shinkeigaku 43:313321, 2003. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 14

    Rafay MF, , Armstrong D, , Deveber G, , Domi T, , Chan A, & MacGregor DL: Craniocervical arterial dissection in children: clinical and radiographic presentation and outcome. J Child Neurol 21:816, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Roach ES, , Golomb MR, , Adams R, , Biller J, , Daniels S, & Deveber G, : Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 39:26442691, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Silverboard G, & Tart R: Cerebrovascular arterial dissection in children and young adults. Semin Pediatr Neurol 7:289300, 2000

  • 17

    Surdell DL, , Bernstein RA, , Hage ZA, , Batjer HH, & Bendok BR: Symptomatic spontaneous intracranial carotid artery dissection treated with a self-expanding intracranial nitinol stent: a case report. Surg Neurol 71:604609, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 444 64 8
Full Text Views 122 8 0
PDF Downloads 173 13 0
EPUB Downloads 0 0 0