Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review

Hoving, Jan W; Marquering, Henk A.; Majoie, Charles B. L. M.

doi:10.1007/s00234-017-1850-y

Cited by 40 publications

(23 citation statements)

References 32 publications

(44 reference statements)

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“…Furthermore, the rate of symptomatic ICH was not higher in patients with CAD, despite our finding that CAD patients suffered from larger occlusions (more distal ICA and ICA-T occlusions) and had a lower ASPECTS score at baseline. Our finding that the rate of complications in EVT-treated patients with CAD is not increased, corresponds with previous research (18, 19).…”

Section: Discussionsupporting

confidence: 93%

“…This can be explained by the fact that patients with CAD were younger and had less cardiovascular risk factors. These findings are consistent with a recent systematic review that showed that a large proportion of patients with tandem occlusion due to CAD achieved functional independency after EVT (18). Furthermore, we observed longer procedural times and lower rates of successful reperfusion in patients with CAD and ACAO.…”

Section: Discussionsupporting

confidence: 92%

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Acute Endovascular Treatment of Patients With Ischemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

et al. 2019

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Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Acute Endovascular Treatment of Patients With Ischemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

et al. 2019

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“…The American College of Radiology recommends that among those with suspected stroke who developed a new focal neurologic deficit, fixed or worsening, in conjunction with MRI of the head, a non-contrast head MRA and contrast-enhanced neck MRA be performed [10]. A systematic review of 16 studies suggested that endovascular treatment for carotid dissection and concomitant proximal intracranial occlusion, using any or combinations of intra-arterial thrombolytic therapy, angioplasty or stenting, was associated with favourable outcome and successful reperfusion; however, the authors warned that most of the included studies had a high risk of bias [11].…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

et al. 2020

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Cervical artery dissection is a rare complication of head and neck trauma. Though it is an infrequent cause of ischaemic stroke, it is more common among the young with cerebral ischaemia. The usual location of carotid dissection is just beyond the carotid bulb. We report a case of post-traumatic internal carotid dissection that began at the base of the skull after blunt head trauma from a road traffic accident. The patient is a 25-year-old right-handed lady who, 2 days after the accident, developed dysphasia and right-sided limb weakness. She had no significant past medical history. Magnetic resonance imaging (MRI) showed acute ischaemic stroke in the internal watershed regions of the left cerebral hemisphere. MR angiogram revealed focal near-occlusion of the left internal carotid artery at the base of the skull just prior to its entry into the petrous temporal bone. There were no skull fractures. She progressed despite anticoagulation. The location of the site of dissection at the base of the skull is likely due to stresses on the carotid intima at this point during flexion-extension-rotation that occurs during head injury, as this is where the internal carotid artery is tethered to the skull. Rapid recognition of symptoms of cerebral ischaemia among patients with blunt head trauma is needed to allow prompt investigation and institution of relevant therapies.

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“…Hoving et al have advised further analysis of treatment trials to assess its therapeutic effectiveness 27…”

Section: Discussionmentioning

confidence: 99%

Eagle’s syndrome: a piercing matter

Zammit¹,

Chircop

Attard

et al. 2018

BMJ Case Rep

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We present an unusual case of Eagle’s syndrome with bilateral internal carotid artery dissection in a 45-year-old man. Initial symptomatology included ipsilateral headaches and facial sensory symptoms. A right horner’s syndrome was present on clinical examination. Radiological imaging revealed an old infarct, with bilateral carotid dissections and bilateral elongated styloid processes consistent with Eagle’s syndrome. Despite initiation of secondary prevention with antiplatelet therapy, he had two further ischaemic events. The case highlights the symptomatology and complications of Eagle’s syndrome, with its management discussed through a review of similar case reports.

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Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review

Cited by 40 publications

References 32 publications

Acute Endovascular Treatment of Patients With Ischemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

Acute Endovascular Treatment of Patients With Ischemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report

Eagle’s syndrome: a piercing matter

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