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Erschienen in:

13.08.2018 | Original Article

Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report

verfasst von: Christopher Alan Hilditch, Waleed Brinjikji, Joanna Schaafsma, Chun On Anderson Tsang, Patrick Nicholson, Ronit Agid, Timo Krings, Vitor M Pereira

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2019

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Abstract

Background and Purpose

Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a case series of extracranial ICA reconstruction using overlapping flow-diverter stents as a rescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management.

Materials and Methods

Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates.

Results

A total of 7 patients were included. The mean age was 47 years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events.

Conclusion

Reconstruction of the ICA as a rescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series.
Literatur
1.
Zurück zum Zitat CADISS trial investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14:361–7.CrossRef CADISS trial investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14:361–7.CrossRef
2.
Zurück zum Zitat Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, Ayrignac X, Bonafé A, Costalat V. Endovascular management of tandem occlusion stroke related to internal carotid artery dissection using a distal to proximal approach: insight from the RECOST study. AJNR Am J Neuroradiol. 2016;37:1281–8.CrossRef Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, Ayrignac X, Bonafé A, Costalat V. Endovascular management of tandem occlusion stroke related to internal carotid artery dissection using a distal to proximal approach: insight from the RECOST study. AJNR Am J Neuroradiol. 2016;37:1281–8.CrossRef
3.
Zurück zum Zitat Krings T, Choi IS. The many faces of intracranial arterial dissections. Interv Neuroradiol. 2010;16:151–60.CrossRef Krings T, Choi IS. The many faces of intracranial arterial dissections. Interv Neuroradiol. 2010;16:151–60.CrossRef
4.
Zurück zum Zitat Kadkhodayan Y, Jeck DT, Moran CJ, Derdeyn CP, Cross DT 3rd. Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol. 2005;26:2328–35.PubMed Kadkhodayan Y, Jeck DT, Moran CJ, Derdeyn CP, Cross DT 3rd. Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm. AJNR Am J Neuroradiol. 2005;26:2328–35.PubMed
5.
Zurück zum Zitat Robertson JJ, Koyfman A. Cervical artery dissections: a review. J Emerg Med. 2016;51(5):508–18.CrossRef Robertson JJ, Koyfman A. Cervical artery dissections: a review. J Emerg Med. 2016;51(5):508–18.CrossRef
6.
Zurück zum Zitat Donas KP, Mayer D, Guber I, Baumgartner R, Genoni M, Lachat M. Endovascular repair of extracranial carotid artery dissection: current status and level of evidence. J Vasc Interv Radiol. 2008;19:1693–8.CrossRef Donas KP, Mayer D, Guber I, Baumgartner R, Genoni M, Lachat M. Endovascular repair of extracranial carotid artery dissection: current status and level of evidence. J Vasc Interv Radiol. 2008;19:1693–8.CrossRef
7.
Zurück zum Zitat Ahlhelm F, Benz RM, Ulmer S, Lyrer P, Stippich C, Engelter S. Endovascular treatment of cervical artery dissection: ten case reports and review of the literature. Interv Neurol. 2013;1:143–50.PubMedPubMedCentral Ahlhelm F, Benz RM, Ulmer S, Lyrer P, Stippich C, Engelter S. Endovascular treatment of cervical artery dissection: ten case reports and review of the literature. Interv Neurol. 2013;1:143–50.PubMedPubMedCentral
8.
Zurück zum Zitat Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017;59:641-7.CrossRef Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017;59:641-7.CrossRef
9.
Zurück zum Zitat Brzezicki G, Rivet DJ, Reavey-Cantwell J. Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series. J Neurointerv Surg. 2016;8:722–8.CrossRef Brzezicki G, Rivet DJ, Reavey-Cantwell J. Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series. J Neurointerv Surg. 2016;8:722–8.CrossRef
10.
Zurück zum Zitat Tsang AC, Leung KM, Lee R, Lui WM, Leung GK. Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device. J Neurointerv Surg. 2015;7:603–7.CrossRef Tsang AC, Leung KM, Lee R, Lui WM, Leung GK. Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device. J Neurointerv Surg. 2015;7:603–7.CrossRef
11.
Zurück zum Zitat Fischer S, Perez MA, Kurre W, Albes G, Bäzner H, Henkes H. Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms: initial experience and long-term follow-up. Neurosurgery. 2014;75:364–74.CrossRef Fischer S, Perez MA, Kurre W, Albes G, Bäzner H, Henkes H. Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms: initial experience and long-term follow-up. Neurosurgery. 2014;75:364–74.CrossRef
12.
Zurück zum Zitat Amuluru K, Al-Mufti F, Roth W, Prestigiacomo CJ, Gandhi CD. Anchoring pipeline flow diverter construct in the treatment of traumatic distal cervical carotid artery injury. Interv Neurol. 2017;6:153–62.CrossRef Amuluru K, Al-Mufti F, Roth W, Prestigiacomo CJ, Gandhi CD. Anchoring pipeline flow diverter construct in the treatment of traumatic distal cervical carotid artery injury. Interv Neurol. 2017;6:153–62.CrossRef
13.
Zurück zum Zitat Kurre W, Bansemir K, Aguilar Pérez M, Martinez Moreno R, Schmid E, Bäzner H, Henkes H. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology. 2016;58:1167–79.CrossRef Kurre W, Bansemir K, Aguilar Pérez M, Martinez Moreno R, Schmid E, Bäzner H, Henkes H. Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology. 2016;58:1167–79.CrossRef
14.
Zurück zum Zitat Lavallée PC, Mazighi M, Saint-Maurice JP, Meseguer E, Abboud H, Klein IF, Houdart E, Amarenco P. Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion. Stroke. 2007;38:2270–4.CrossRef Lavallée PC, Mazighi M, Saint-Maurice JP, Meseguer E, Abboud H, Klein IF, Houdart E, Amarenco P. Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion. Stroke. 2007;38:2270–4.CrossRef
15.
Zurück zum Zitat Biousse V, D’Anglejan-Chatillon J, Touboul PJ, Amarenco P, Bousser MG. Time course of symptoms in extracranial carotid artery dissections : a series of 80 patients. Stroke. 1995;26:235–9.CrossRef Biousse V, D’Anglejan-Chatillon J, Touboul PJ, Amarenco P, Bousser MG. Time course of symptoms in extracranial carotid artery dissections : a series of 80 patients. Stroke. 1995;26:235–9.CrossRef
16.
Zurück zum Zitat Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW; Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutic trial? Stroke. 2003;34:2856–60.CrossRef Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW; Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutic trial? Stroke. 2003;34:2856–60.CrossRef
17.
Zurück zum Zitat Beletsky V, Norris JW. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;345:467.PubMed Beletsky V, Norris JW. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;345:467.PubMed
18.
Zurück zum Zitat Müller BT, Luther B, Hort W, Neumann-Haefelin T, Aulich A, Sandmann W. Surgical treatment of 50 carotid dissections: Indications and results. J Vasc Surg. 2000;31:980–8.CrossRef Müller BT, Luther B, Hort W, Neumann-Haefelin T, Aulich A, Sandmann W. Surgical treatment of 50 carotid dissections: Indications and results. J Vasc Surg. 2000;31:980–8.CrossRef
Metadaten
Titel
Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report
verfasst von
Christopher Alan Hilditch
Waleed Brinjikji
Joanna Schaafsma
Chun On Anderson Tsang
Patrick Nicholson
Ronit Agid
Timo Krings
Vitor M Pereira
Publikationsdatum
13.08.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Neuroradiology / Ausgabe 4/2019
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-018-0707-z

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