Prevalence and treatment of spontaneous intracranial artery dissections in patients with acute stroke due to intracranial large vessel occlusion

Labeyrie, Marc‐Antoine; Civelli, Vittorio; Reiner, Peggy; Aymard, A; Saint‐Maurice, Jean‐Pierre; Zetchi, Akli; Houdart, Emmanuel

doi:10.1136/neurintsurg-2018-013763

Cited by 23 publications

(36 citation statements)

References 14 publications

(16 reference statements)

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“…In the study by Labeyrie et al stenting of IAD was used as first-line approach to rescue patients with acute stroke due to intracranial large vessel occlusion. However, without the guidance of OCT, stenting of a circulating false lumen failed to recanalize the artery in 2 (25%) out of 8 patients ( 4 ). Therefore, one can expect that OCT-guided stenting may be secure and reliable to manage IAD because it may circumvent risk of stenting in a false lumen and achieve covering of dissection with full length.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study suggested the use of self-expanding stents to treat IAD as a first-line approach to recanalize IAD ( 4 ). In our case, there were two aspects that may explain the decreased efficacy of permanent stenting in the treatment of IAD.…”

Section: Discussionmentioning

confidence: 99%

“…In Italy, the prevalence of IAD was 23/4400 (0.5%) among patients with a diagnosis of cerebral ischemia ( 3 ). Another study from France demonstrated spontaneous IAD to account for 3.3% (13/391) of patients with acute ischemic stroke due to large vessel occlusion (LVO) ( 4 ). However, in Asia, IAD is not such a rare diagnosis with its reported prevalence of up to 20.5% (192/937) among patients with intracranial atherosclerotic narrowing on TOF-MRA ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Multimodal imaging techniques are often needed to confirm the diagnosis of IAD ( 8 ). In most cases, IAD is defined based on angiographic criteria rather than magnetic resonance imaging given its clinical presentation as an acute stroke ( 4 , 8 ). The prevalence of the pathognomonic finding of IAD—the mural hematoma may be underdiagnosed by luminal examination alone and many Asian patients with IAD may be misclassified as having intracranial atherosclerotic disease ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Optical Coherence Tomography of Spontaneous Basilar Artery Dissection in a Patient With Acute Ischemic Stroke

Gao

Gui²,

Yang

et al. 2018

Front. Neurol.

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The diagnosis of intracranial arterial dissection (IAD) may be challenging and multimodal imaging techniques are often needed to confirm the diagnosis. Previous studies have based their criteria for diagnosis of IAD on conventional angiography, computed tomography, or magnetic resonance imaging. We report a case with acute ischemic stroke due to spontaneous basilar artery dissection in which intravascular optical coherence tomography (OCT) was used to show features of IAD. A 59-years-old woman presented with symptoms of acute ischemic stroke. Thrombosis related to basilar artery (BA) stenosis was assumed on conventional angiography; however, no clot was retrieved after mechanical thrombectomy (MT) and a restored BA caliber was observed after a rescue recanalization with the detachment of a self-expanding stent was performed. Spontaneous IAD was suspected; however, angiographic findings were ambiguous for confirming IAD. The patient remained symptom-free until 18-months follow-up. At this point, angiography showed restenosis at the proximal tapered length of the stent. In vivo OCT was performed to assess the pathological changes of the restenosis and confirm the diagnosis of IAD.OCT revealed BA dissection with the presence of remnant transverse flap, double lumen and mural hematoma. Imaging at multiple levels identified intimal disruption that originated in the right vertebral artery and extended distally to the BA. The use of intravascular imaging with OCT enabled the accurate diagnosis of IAD. Care should be taken as the procedure may add additional risks to the patient. Future studies are needed to validate the safety of OCT in IAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optical Coherence Tomography of Spontaneous Basilar Artery Dissection in a Patient With Acute Ischemic Stroke

Gao

Gui²,

Yang

et al. 2018

Front. Neurol.

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“…Five or more passes of the stent retriever became futile in terms of the recanalization rate and functional outcomes [113]. When mechanical thrombectomy does not retrieve any clot, besides underlying atherosclerotic stenotic lesion, also spontaneous intracranial arterial dissection should be considered as a cause of large vessel occlusion [114]. Dual stent retriever technique [115] and rescue stenting were used as alternatives for failed mechanical thrombectomy [116].…”

Section: First-pass Effectmentioning

confidence: 99%

How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods

Zeleňák

Krajina

Meyer

et al. 2021

Life

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Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and collecting of extremely big databases. Nowadays, the speed of internet connection is a limiting factor for robotic systems, which can be controlled and commanded potentially from various places in the world. Innovative technologies can be implemented for acute stroke patient management soon. Artificial intelligence (AI) and robotics are used increasingly often without the exception of medicine. Their implementation can be achieved in every level of stroke care. In this article, all steps of stroke health care processes are discussed in terms of how to improve them (including prehospital diagnosis, consultation, transfer of the patient, diagnosis, techniques of the treatment as well as rehabilitation and usage of AI). New ethical problems have also been discovered. Everything must be aligned to the concept of “time is brain”.

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Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

Bernardo

Nannoni

Strambo

et al. 2019

J Thromb Thrombolysis

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Prevalence and treatment of spontaneous intracranial artery dissections in patients with acute stroke due to intracranial large vessel occlusion

Cited by 23 publications

References 14 publications

Optical Coherence Tomography of Spontaneous Basilar Artery Dissection in a Patient With Acute Ischemic Stroke

Optical Coherence Tomography of Spontaneous Basilar Artery Dissection in a Patient With Acute Ischemic Stroke

How to Improve the Management of Acute Ischemic Stroke by Modern Technologies, Artificial Intelligence, and New Treatment Methods

Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

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