Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach

Delgado, Fernando; Bravo, Isabel; Jiménez, E Ciércoles; Murías, Eduardo; Sáiz, Antonio; Vega, Pedro; López-Rueda, Antonio; Blasco, Jordi; Macho, Juan; González, Alejandro

doi:10.1136/neurintsurg-2016-012475

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…Our EVT procedure differed from that employed to treat atherosclerotic stenosis. In our patients, the lesions were considerably higher and/or extended, and the dissected segment requiring treatment was longer than atherosclerosis (18). However, in most patients, if the entry zone of the dissected intima is fully covered, a 40 mm stent is sufficient.…”

Section: Discussionmentioning

confidence: 69%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 69%

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

et al. 2022

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“…Farouk et al [ 5 ] investigated endovascular treatment is useful for acute ischemic stroke induced by carotid dissection. Delgado et al [ 3 ] reported that endovascular treatment of selected cases of patients presents good short-term clinical results for acute and non-acute phases of carotid dissections. All patients with non-acute phase of cervical arterial dissection in this present study demonstrate improvement resolution of presenting symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…For the high-grade stenosis (>70%) or occluded ESAD, postoperative systolic blood pressure (generally 90–120 mmHg) should be monitored strictly to avoid hyper-perfusion syndrome or hemorrhage. The non-acute phase of ESAD was defined as after 8 hours from symptom onset [ 3 ]. Acute phase ESAD cases have high basal National Institutes of Health Stroke Scale (NIHSS) score, more unilateral lesions and relatively poor prognosis.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections

Jiang¹,

Di²,

Lü³

et al. 2022

J Korean Neurosurg Soc

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Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs.Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed.Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5–77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91).Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

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“…Since we had no data on the use of Viabahn stent in conjunction with MT, and these cases were performed before the publication of a recent prospective registry, we judged it reasonable to customize the periprocedural antithrombotic therapy based on the clinical characteristics of patients on a case-by-case basis [23], per the standard practice in our center. In summary, we decided to postpone the antiplatelet therapy until a brain CT ruled out signs of hemorrhage in patients who received intravenous tPA previously and in those cases where the procedure was more complex and longer, as longer procedure duration increases the risk of periprocedural complications.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion

Piñana

Gramegna

Folleco

et al. 2020

Cardiovasc Intervent Radiol

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Introduction Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center. Methods A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d'Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded. Results A total of eight patients were treated with the covered stents, and we observed significant improvement in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence. ConclusionThe preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS.

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Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach

Abstract: Endovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.

Cited by 9 publications

References 27 publications

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

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

Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections

Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion

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