Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

Abstract

Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.

Utility of Pipeline embolization device for emergency recanalization of a dissecting carotid tonsillar loop: illustrative cases

“…6,7 However, because their low pore density and radial force may cause thrombus migration from the pseudolumen into the stents and insufficient opening of the stenoocclusive segment, these devices may not be appropriate for carotid dissection. In contrast, Zussman et al 8 demonstrated the efficiency of telescoping-stent reconstruction of the carotid tonsillar loop dissection using Zilver self-expanding peripheral stents. However, in one of the present cases (case 1), this stent delivery system could not progress through the looped segment, whereas the PED delivery system was easily navigated through the lesion.…”