Christopher Alan Hilditch1, Waleed Brinjikji2, Joanna Schaafsma3, Chun On Anderson Tsang2, Patrick Nicholson2, Ronit Agid2, Timo Krings2,4, Vitor M Pereira2,4. 1. Division of Neuroradiology, Joint Division of Medical Imaging, University Health Network, University of Toronto, 399 Bathurst St, ON M5T 2S8, Toronto, Canada. hilditchca@gmail.com. 2. Division of Neuroradiology, Joint Division of Medical Imaging, University Health Network, University of Toronto, 399 Bathurst St, ON M5T 2S8, Toronto, Canada. 3. Division of Neurology, Toronto Western Hospital, Toronto, Canada. 4. Division of Neurosurgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND AND PURPOSE: Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management. MATERIALS AND METHODS: Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates. RESULTS: A total of 7 patients were included. The mean age was 47 years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events. CONCLUSION: Reconstruction of the ICA as a rescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series.
BACKGROUND AND PURPOSE: Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management. MATERIALS AND METHODS: Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates. RESULTS: A total of 7 patients were included. The mean age was 47 years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events. CONCLUSION: Reconstruction of the ICA as a rescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series.
Authors: Wiebke Kurre; Kai Bansemir; Marta Aguilar Pérez; Rosa Martinez Moreno; Elisabeth Schmid; Hansjörg Bäzner; Hans Henkes Journal: Neuroradiology Date: 2016-10-29 Impact factor: 2.804
Authors: G Marnat; I Mourand; O Eker; P Machi; C Arquizan; C Riquelme; X Ayrignac; A Bonafé; V Costalat Journal: AJNR Am J Neuroradiol Date: 2016-03-10 Impact factor: 3.825