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Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience.

Publication ,  Journal Article
Ohta, H; Natarajan, SK; Hauck, EF; Khalessi, AA; Siddiqui, AH; Hopkins, LN; Levy, EI
Published in: J Neurosurg
July 2011

OBJECT: The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs). METHODS: Retrospective review of data at Millard Fillmore Gates Hospital identified 43 patients with 44 CADs (intracranial and/or extracranial) treated with carotid artery (CA) stent placement between January 2000 and June 2009. RESULTS: Thirty-two CADs were spontaneous and 12 were traumatic; 35 were symptomatic. Lesion locations included the extracranial internal CA (ICA; 24 cases), extracranial ICA with common CA involvement (4 cases), and extracranial ICA-intracranial ICA (16 cases). Carotid artery occlusion was 100% in 15 cases (34.1%), 99% in 6 cases (13.6%), 70%-98% in 13 cases (29.5%), and < 70% in 10 cases (22.7%). Five patients suffered pseudoaneurysms. Stent deployment was successful in 43 (97.7%) of 44 cases. The mean pretreatment score on the National Institutes of Health Stroke Scale was 6.2 ± 6.2. Recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3) was accomplished for 42 lesions (95.5%). Four patients demonstrated residual parent vessel stenosis (10%-50% in severity). Procedure-related complications occurred in 7 patients and included middle cerebral artery embolism (1 patient), intracranial hemorrhage (2 patients), worsening of dissection (1 patient), stent malpositioning (1 patient), embolic protection filter overload (1 patient), and filter retrieval device fracture (1 patient). Only 2 of these complications caused permanent deficits: the embolism caused a minor but permanent neurological deficit, and 1 intracranial hemorrhage was fatal. At discharge, 36 patients (83.7%) had modified Rankin Scale scores of 0-2 (favorable outcome). During the follow-up interval (mean 19.2 months, range 4-92 months), no patient suffered a new stroke and 1 patient died secondary to preexisting chronic renal failure. In 20 patients with angiographic follow-up, permanent resolution of the dissection was noted in 90.5%; 2 lesions (9.5%) required retreatment. CONCLUSIONS: Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.

Duke Scholars

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

July 2011

Volume

115

Issue

1

Start / End Page

91 / 100

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Cerebral Angiography
 

Citation

APA
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Ohta, H., Natarajan, S. K., Hauck, E. F., Khalessi, A. A., Siddiqui, A. H., Hopkins, L. N., & Levy, E. I. (2011). Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience. J Neurosurg, 115(1), 91–100. https://doi.org/10.3171/2011.1.JNS091806
Ohta, Hajime, Sabareesh K. Natarajan, Erik F. Hauck, Alexander A. Khalessi, Adnan H. Siddiqui, L Nelson Hopkins, and Elad I. Levy. “Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience.J Neurosurg 115, no. 1 (July 2011): 91–100. https://doi.org/10.3171/2011.1.JNS091806.
Ohta H, Natarajan SK, Hauck EF, Khalessi AA, Siddiqui AH, Hopkins LN, et al. Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience. J Neurosurg. 2011 Jul;115(1):91–100.
Ohta, Hajime, et al. “Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience.J Neurosurg, vol. 115, no. 1, July 2011, pp. 91–100. Pubmed, doi:10.3171/2011.1.JNS091806.
Ohta H, Natarajan SK, Hauck EF, Khalessi AA, Siddiqui AH, Hopkins LN, Levy EI. Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience. J Neurosurg. 2011 Jul;115(1):91–100.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

July 2011

Volume

115

Issue

1

Start / End Page

91 / 100

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Cerebral Angiography