Unplanned 30-Day Hospital Readmissions of Symptomatic Carotid and Vertebral Artery Dissection

Mehta, Tapan; Patel, Smit; Male, Shailesh; Parikh, Romil; Mehta, Kathan; Lakshminarayan, Kamakshi; Tummala, Ramachandra P.; Ezzeddine, Mustapha A.

doi:10.5853/jos.2018.02236

Cited by 4 publications

(6 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unplanned 30-day hospital readmissions of symptomatic carotid and VA dissection reach the 9.08% and 8.43% respectively while primary cause of readmission was ischemic stroke [ 11 ]. Though the previous study not distinguish location of dissection (intra vs. extracranial), outcomes still contribute understanding of the development of carotid and vertebral dissections.…”

Section: Discussionmentioning

confidence: 99%

“…Though the previous study not distinguish location of dissection (intra vs. extracranial), outcomes still contribute understanding of the development of carotid and vertebral dissections. Several studies presume that endovascular stenting is reserved for cases failed medical therapy [ 11 ]. However, in this present study, stent remodeling of extracranial supra-aortic arterial dissection with high-grade stenosis (>70%) or occlusion, and aneurysmal dilations was proved safely and efficaciously with 99% technical success rate.…”

Section: Discussionmentioning

confidence: 99%

“…Extracranial supra-aortic dissections (ESADs) mainly include carotid arterial dissection (CAD) and vertebral arterial dissection (VAD) estimated at 3–4 per 100000 [ 15 ], which are generally accepted as the etiology of cerebral ischemia, particularly in younger patients (<45 years old) accounting for up to 25% of all ischemic strokes [ 2 , 9 ]. Prior study has shown 4.14% and 1.6% readmission due to ischemic stroke recurrence in patients with symptomatic carotid and vertebral dissections respectively [ 11 ]. Endovascular stenting treatment for patients with ESAD is a potentially more effective option than standalone antiplatelet or anticoagulants.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Jiang¹,

Di²,

Lü³

et al. 2022

J Korean Neurosurg Soc

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Jiang¹,

Di²,

Lü³

et al. 2022

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…37,52,53 Individuals with VAD are later re-hospitalized with ischemic stroke at a higher rate compared with those with CAD. 54…”

Section: Discussionmentioning

confidence: 99%

Vertebral Artery Dissection in a Woman Due to Golf

Gallaer

Archambault²,

Patel³

et al. 2021

The Neurologist

View full text Add to dashboard Cite

Introduction: Traditionally, spontaneous cervical artery dissections have been associated with violent, sudden neck movements. These events are a significant cause of stroke related morbidity, particularly in young people. Only a handful of cases of golf-induced vertebral artery dissection (VAD) have been described, and the discussion has primarily focused on middle-aged men. Despite the discussion focused on this demographic, women are participating in golf at higher rates than ever before, and have a higher risk for developing VAD. Case Report: A 41-year-old woman presented to our hospital with sharp neck pain, dizziness, and ptosis after swinging a driver during a morning round of golf. Imaging demonstrated a right V3/V4 VAD and subsequent ischemic infarction. After administration of tissue plasminogen activator she had abrupt change in mental status with seizure-like activity. She underwent angiogram and mechanical thrombectomy, and was started in heparin 24 hours post-tissue plasminogen activator. This was subsequently changed to low-dose aspirin following thalamic petechial hemorrhage. She was discharged from the hospital after a few days with only minor deficits. We will discuss mechanism, treatment, and outcomes of VAD in context of this case. Conclusion: This patient is the first woman in the literature to suffer from VAD as a result of playing golf. The twisting motion of the head and neck in a golf swing may be a risk factor for dissection and subsequent development of stroke. As a result of increased female participation in golf, we expect to see increased incidence of women presenting with “golfer’s stroke” in coming years.

show abstract

“…This can result in ischemic stroke from artery-to-artery embolization, hypoperfusion, or a combination of both mechanisms, although the former is the more common reason. [ 1 2 ]…”

Section: Introductionmentioning

confidence: 99%

Recanalization of cervicocephalic artery dissection

et al. 2020

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: While there exists a substantial literature on the risk factors and clinical manifestations of cervical artery dissection (CeAD) including carotid and vertebral artery, little is known about postdissection recanalization. The goal of our study was to provide a descriptive analysis of CeAD and recanalization after dissection with neuroimaging follow up. METHODS: We retrospectively analyzed 51 consecutive patients with confirmed diagnoses of CeAD based on neuroimaging. Demographic data, risk factors, and dissection characteristics were recorded. Neuroimaging studies were performed at 0, 3, 6, and >6 months. RESULTS: Among 51 cases, the mean age of dissection (mean ± standard error) was 49.4 ± 1.92 years, and female comprised 58.8% of the patients. Extent of stenosis was 100% dissection in 37.3%, 51%–99% in 41.2%, and <51% in 21.5%. The most common presenting symptoms were headache (54.9%), neck pain (49.0%), and dizziness/gait imbalance (39.2%). The most common associated risk factors were recent history of trauma to the head and neck (41.2%) and hypertension (41.2%). In follow-up imaging, overall, 47.1% (24/51) had complete recanalization (CR), while 35.3% (18/51) did not; in the former group, 75% (18/24) recanalized completely during the first 6 months following symptom onset. A majority (84.3%) of the patients were discharged home, 15.7% were discharged to a facility, and no mortality was reported. Interestingly, location, type-/nature of dissection, and treatment did not statistically appear to influence the likelihood of recanalization. CONCLUSIONS: The recanalization of CeAD occurs mainly within the first 6 months after symptom onset, following which healing slows down. The study did not find an association between location, pattern, or nature of dissection on artery recanalization.

show abstract

Unplanned 30-Day Hospital Readmissions of Symptomatic Carotid and Vertebral Artery Dissection

Cited by 4 publications

References 6 publications

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

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

Vertebral Artery Dissection in a Woman Due to Golf

Recanalization of cervicocephalic artery dissection

Contact Info

Product

Resources

About