Clinical Outcomes of Endovascular Treatment for Carotid Artery Dissection Without Intracranial Large Vessel Occlusion in Patients With Cerebral Ischemia Presentation

Abstract

Background and PurposeWe describe the clinical characteristics and outcomes (including the long-term patency of endovascular treatment [EVT]) of patients with acute ischemic strokes (AISs) featuring carotid artery dissection (CAD) but not intracranial large vessel occlusion.MethodsWe retrospectively reviewed patients who underwent EVT for spontaneous or post-traumatic AISs with CAD over a 13 year period from September 2005 to November 2018. The indications for EVT in patients with AIS-related CAD were a pretreatment diffusion-weighted imaging-Alberta Stroke Program early computed tomography (ASPECT) score > 6 and, clinical-diffusion mismatch. But, if the patients showed fluctuated ischemic symptoms, the joint decision by a stroke neurologist and neurointerventionist was done according to the onset-to-door time, symptoms, patient data, and the initial neuroimaging findings whether indicated that EVT was appropriate.ResultsTwenty-two dissected carotid arteries underwent balloon angioplasty and/or stent placement. The patients were 6 women and 16 men of median age 46 years. Twelve lacked any trauma history. Recombinant tissue plasminogen activator was prescribed for two (9.1%) patients. Four developed symptomatic intracranial hemorrhages (18.2%) but 86.4% exhibited modified Rankin scores ≤ 2.ConclusionsAlthough attention to the hemorrhagic complication is required, EVT for selective patients with cerebral ischemia associated with CAD may be safe and acceptable treatment strategy for reconstruction of luminal patency, with good clinical outcomes. Prospective large-scale randomized studies are required to optimize EVT for CAD patients.

Diagnosis and treatment of acute isolated proximal internal carotid artery occlusions: a narrative review

“…Indeed, a recent study of 22 patients treated with angioplasty assisted stenting for acute ICA dissections reported sICH rates of 18.2%. 64 Moreover, dissections typically involve a longer arterial segment than atherosclerosis, necessitating longer or multiple stent deployment. Nevertheless, several case series have reported high rates of recanalization and an overall technical success of the endovascular procedure for the treatment of ICA dissections, coupled with high functional independence rates of >80%, especially in the absence of tandem occlusions.…”

“…[64][65][66][67] On the contrary, the risk of distal embolization seems lower, and thus use of distal protection devices is not critical. 64 However, in these studies only subgroups were treated in an emergency LVO context due to dissection-related pICAO. The majority of the patients presented with non-occlusive extracranial dissections.…”

“…Nevertheless, several case series have reported high rates of recanalization and an overall technical success of the endovascular procedure for the treatment of ICA dissections, coupled with high functional independence rates of >80%, especially in the absence of tandem occlusions. [64][65][66][67] On the contrary, the risk of distal embolization seems lower, and thus use of distal protection devices is not critical. 64 However, in these studies only subgroups were treated in an emergency LVO context due to dissection-related pICAO.…”