Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience

Clinical article

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  • 1 Departments of Neurosurgery and
  • 2 Radiology, and
  • 3 Toshiba Stroke Research Center, 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
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Object

The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs).

Methods

Retrospective review of data at Millard Fillmore Gates Hospital identified 43 patients with 44 CADs (intracranial and/or extracranial) treated with carotid artery (CA) stent placement between January 2000 and June 2009.

Results

Thirty-two CADs were spontaneous and 12 were traumatic; 35 were symptomatic. Lesion locations included the extracranial internal CA (ICA; 24 cases), extracranial ICA with common CA involvement (4 cases), and extracranial ICA–intracranial ICA (16 cases). Carotid artery occlusion was 100% in 15 cases (34.1%), 99% in 6 cases (13.6%), 70%–98% in 13 cases (29.5%), and < 70% in 10 cases (22.7%). Five patients suffered pseudoaneurysms. Stent deployment was successful in 43 (97.7%) of 44 cases. The mean pretreatment score on the National Institutes of Health Stroke Scale was 6.2 ± 6.2. Recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3) was accomplished for 42 lesions (95.5%). Four patients demonstrated residual parent vessel stenosis (10%–50% in severity). Procedure-related complications occurred in 7 patients and included middle cerebral artery embolism (1 patient), intracranial hemorrhage (2 patients), worsening of dissection (1 patient), stent malpositioning (1 patient), embolic protection filter overload (1 patient), and filter retrieval device fracture (1 patient). Only 2 of these complications caused permanent deficits: the embolism caused a minor but permanent neurological deficit, and 1 intracranial hemorrhage was fatal. At discharge, 36 patients (83.7%) had modified Rankin Scale scores of 0–2 (favorable outcome). During the follow-up interval (mean 19.2 months, range 4–92 months), no patient suffered a new stroke and 1 patient died secondary to preexisting chronic renal failure. In 20 patients with angiographic follow-up, permanent resolution of the dissection was noted in 90.5%; 2 lesions (9.5%) required retreatment.

Conclusions

Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.

Abbreviations used in this paper: CA = carotid artery; CAD = CA dissection; CCA = common CA; ICA = internal CA; ICH = intracranial hemorrhage; MCA = middle cerebral artery; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; TIA = transient ischemic attack; TIMI = Thrombolysis in Myocardial Infarction.

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Contributor Notes

Address correspondence to: Elad I. Levy, M.D., University at Buffalo Neurosurgery, 3 Gates Circle, Buffalo, New York 14209. email: elevy@ubns.com.

Please include this information when citing this paper: published online March 18, 2011; DOI: 10.3171/2011.1.JNS091806.

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