Abstract
Purpose
To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections.
Methods
Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series.
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References
WI Schievink (2001) ArticleTitleSpontaneous dissection of the carotid and vertebral arteries N Engl J Med 344 898–906 Occurrence Handle1:STN:280:DC%2BD3M7nsV2ltQ%3D%3D Occurrence Handle10.1056/NEJM200103223441206 Occurrence Handle11259724
C Kitanaka T Sasaki T Eguchi et al. (1994) ArticleTitleIntracranial vertebral artery dissections: Clinical, radiological features, and surgical considerations Neurosurgery 34 620–627 Occurrence Handle1:STN:280:DyaK2c3nslejsA%3D%3D Occurrence Handle10.1227/00006123-199404000-00008 Occurrence Handle8008158
T Mizutani T Aruga T Kirino et al. (1995) ArticleTitleRecurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms Neurosurgery 36 905–913 Occurrence Handle1:STN:280:DyaK2Mzht1WqsQ%3D%3D Occurrence Handle10.1227/00006123-199505000-00003 Occurrence Handle7791980
JM Provenzale JC Morgenlander D Gress (1996) ArticleTitleSpontaneous vertebral dissection: Clinical, conventional angiographic, CT, and MR findings J Comput Assist Tomogr 20 185–193 Occurrence Handle1:STN:280:DyaK287osVartg%3D%3D Occurrence Handle10.1097/00004728-199603000-00004 Occurrence Handle8606221
A Yamaura Y Watanabe N Saeki (1990) ArticleTitleDissecting aneurysms of the intracranial vertebral artery J Neurosurg 72 183–188 Occurrence Handle1:STN:280:DyaK3c7htFyhtQ%3D%3D Occurrence Handle10.3171/jns.1990.72.2.0183 Occurrence Handle2404089
de Bray JM, Penisson-Besnier I, Dubas F, et al (1997) Extracranial and intracranial vertebrobasilar dissections: Diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63:46–51
C Kitanaka J Tanaki M Kuwahara et al. (1994) ArticleTitleNonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography J Neurosurg 80 667–674 Occurrence Handle1:STN:280:DyaK2c3gtFygsQ%3D%3D Occurrence Handle10.3171/jns.1994.80.4.0667 Occurrence Handle8151345
Mokri B, Houser OW, Sandok BA, et al (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–885
Y Yoshimoto S Wakai (1997) ArticleTitleUnruptured intracranial vertebral artery dissection: Clinical course and serial radiographic imagings Stroke 28 370–374 Occurrence Handle1:STN:280:DyaK2s7ptlWjsg%3D%3D Occurrence Handle10.1161/01.STR.28.2.370 Occurrence Handle9040692
K Iihara N Sakai K Murao et al. (2002) ArticleTitleDissecting aneurysms of the vertebral artery: A management strategy J Neurosurg 97 259–267 Occurrence Handle10.3171/jns.2002.97.2.0259 Occurrence Handle12186451
E Uhl R Schmid-Elsaesser HJ Steiger (2003) ArticleTitleRuptured intracranial dissecting aneurysms: Management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity Acta Neurochir 145 1073–1084 Occurrence Handle1:STN:280:DC%2BD3srotFGisw%3D%3D Occurrence Handle10.1007/s00701-003-0122-2 Occurrence Handle14663564
H Ohkuma T Nakano H Manabe et al. (2002) ArticleTitleSubarachnoid hemorrhage caused by a dissecting aneurysm of the internal carotid artery J Neurosurg 97 576–583 Occurrence Handle10.3171/jns.2002.97.3.0576 Occurrence Handle12296641
R Anxionnat JF Melo Neto Particlede S Bracard et al. (2003) ArticleTitleTreatment of hemorrhagic intracranial dissections Neurosurgery 53 289–301 Occurrence Handle10.1227/01.NEU.0000073417.01297.93 Occurrence Handle12925243
Kai Y, Hamada JI, Morioka M, et al (2003) Endovascular coil trapping for ruptured vertebral artery dissecting aneurysms by using double microcatheters technique in the acute stage. Acta Neurochir 145:447–451
I Naito T Iwai T Sasaki (2002) ArticleTitleManagement of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage Neurosurgery 51 930–938 Occurrence Handle12234399
Leibowitz R, Do HM, Marcellus ML, et al (2003) Parent vessel occlusion for vertebrobasilar fusiform and dissecting aneurysms. AJNR Am J Neuroradiol 24:902–907
Rabinov JD, Hellinger FR, Morris PP, et al (2003) Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:1421–1428
T Yasui M Komiyama M Nishikawa et al. (2000) ArticleTitleSubarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: Report of two cases and review of the literature Neurosurgery 46 196–201 Occurrence Handle1:STN:280:DC%2BD3c%2FptVektA%3D%3D Occurrence Handle10.1097/00006123-200001000-00038 Occurrence Handle10626950
MK Hong LF Satler R Gallino et al. (1997) ArticleTitleIntravascular stenting as a definitive treatment of spontaneous carotid artery dissection Am J Cardiol 79 538 Occurrence Handle1:STN:280:DyaK2s3gsVyltA%3D%3D Occurrence Handle10.1016/S0002-9149(96)00808-9 Occurrence Handle9052373
Dorros G, Cohn JM, Palmer LE (1998) Stent deployment resolves a petrous carotid artery angioplasty dissection. AJNR Am J Neuroradiol 19:392–394
Matsuura JH, Rosenthal D, Jerius H, et al (1997) Traumatic carotid artery dissection and pseudoaneurysm treated with endovascular coils and stent. J Endovasc Surg 4:339–343
GK Bejjani LH Monsein JR Laird et al. (1999) ArticleTitleTreatment of symptomatic cervical carotid dissections with endovascular stents Neurosurgery 44 755–761 Occurrence Handle1:STN:280:DyaK1M3hsFCrsQ%3D%3D Occurrence Handle10.1097/00006123-199904000-00037 Occurrence Handle10201300
Cohen JE, Gomori JM, Umansky F (2003) Endovascular management of spontaneous bilateral symptomatic vertebral artery dissections. AJNR Am J Neuroradiol 24:2052–2056
J DeOcampo J Brillman DI Levy (1997) ArticleTitleStenting: A new approach to carotid dissection J Neuroimaging 7 187–190 Occurrence Handle1:STN:280:DyaK2szotVKrtw%3D%3D Occurrence Handle10.1111/jon199773187 Occurrence Handle9237440
Willing SJ, Skidmore F, Donaldson J, et al (2003) Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: Report of two cases. AJNR Am J Neuroradiol 24:985–989
P Lylyk JE Cohen R Ceratto et al. (2001) ArticleTitleCombined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils J Neurosurg 94 427–432 Occurrence Handle1:STN:280:DC%2BD3M7nsVOjsQ%3D%3D Occurrence Handle10.3171/jns.2001.94.3.0427 Occurrence Handle11235947
G Lanzino AK Wakhloo RD Fessler et al. (1999) ArticleTitleEfficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms J Neurosurg 91 538–546 Occurrence Handle1:STN:280:DyaK1MvjsFajtA%3D%3D Occurrence Handle10.3171/jns.1999.91.4.0538 Occurrence Handle10507372
AK Wakhloo G Lanzino BB Lieber et al. (1998) ArticleTitleStents for intracranial aneurysms: The beginning of a new endovascular era? Neurosurgery 43 377–379 Occurrence Handle1:STN:280:DyaK1czlvFartg%3D%3D Occurrence Handle10.1097/00006123-199808000-00126 Occurrence Handle9696095
N Aoki T Sakai (1990) ArticleTitleRebleeding from intracranial dissecting aneurysm in the vertebral artery Stroke 21 1628–1631 Occurrence Handle1:STN:280:DyaK3M%2FkvVKqug%3D%3D Occurrence Handle10.1161/01.STR.21.11.1628 Occurrence Handle2237959
T Tsukahara H Wada K Satake et al. (1995) ArticleTitleProximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage Neurosurgery 36 914–920 Occurrence Handle1:STN:280:DyaK2Mzht1Wqtg%3D%3D Occurrence Handle10.1227/00006123-199505000-00004 Occurrence Handle7791981
MB Horowitz PD Purdy (2000) ArticleTitleThe use of stents in the management of neurovascular disease: A review of historical and present status Neurosurgery 46 1335–1342 Occurrence Handle1:STN:280:DC%2BD3c3pt1Cqsw%3D%3D Occurrence Handle10.1097/00006123-200006000-00010 Occurrence Handle10834639
Coric D, Wilson JA, Regan JD, et al (1998) Primary stenting of the extracranial internal carotid artery in a patient with multiple cervical dissections. Technical case report. Neurosurgery 43:956–959
Horowitz MB, Miller G 3rd, Meyer Y, et al (1996) Use of intravascular stents in the treatment of internal carotid and extracranial vertebral artery pseudoaneurysms. AJNR Am J Neuroradiol 17:693–696
Massoud TF, Turjman F, Ji C, et al (1995) Endovascular treatment of fusiform aneurysms with stents and coils: Technical feasibility in a swine model. AJNR Am J Neuroradiol 16:1953-1963
Irie K, Negoro M, Hayakawa M, et al (2003) Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization. Neuroradiology 45:825–829
P Lylyk R Ceratto D Hurvitz et al. (1998) ArticleTitleTreatment of a vertebral dissecting aneurysm with stents and coils: Technical case report Neurosurgery 43 385–388 Occurrence Handle1:STN:280:DyaK1czlvFartA%3D%3D Occurrence Handle10.1097/00006123-199808000-00132 Occurrence Handle9696097
CC Phatouros TY Sasaki RT Higashida et al. (2000) ArticleTitleStent-supported coil embolization: The treatment of fusiform and wide-neck aneurysms and pseudoaneurysms Neurosurgery 47 107–115 Occurrence Handle1:STN:280:DC%2BD3M%2FnsV2gtA%3D%3D Occurrence Handle10917353
Bai H, Masuda J, Sawa Y, et al (1994) Neointima formation after vascular stent implantation. Spatial and chronological distribution of smooth muscle cell proliferation and phenotypic modulation. Arterioscler Thromb Vasc Biol 14:1846–1853
JC Chiaradio L Guzman L Padilla et al. (2002) ArticleTitleIntravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: Technical case report Neurosurgery 50 213–216 Occurrence Handle11844254
MJ Alexander TP Smith DL Tucci (2002) ArticleTitleTreatment of an iatrogenic petrous carotid artery pseudoaneurysm with a Symbiot covered stent: Technical case report Neurosurgery 50 658–662 Occurrence Handle11841739
S Felber H Henkes W Weber et al. (2004) ArticleTitleTreatment of extracranial and intracranial aneurysms and arteriovenous fistulae using stent grafts Neurosurgery 55 631–639 Occurrence Handle10.1227/01.NEU.0000134455.02947.1F Occurrence Handle15335430
L Sekhon M Morgan W Sorby et al. (1998) ArticleTitleCombined endovascular stent implantation and endosaccular coil placement for the treatment of a wide-necked vertebral artery aneurysm Technical case report Neurosurgery 43 380–383 Occurrence Handle1:STN:280:DyaK1czlvFartw%3D%3D Occurrence Handle10.1097/00006123-199808000-00127 Occurrence Handle9696096
JC Parodi (1995) ArticleTitleEndovascular repair of abdominal aortic aneurysms and other arterial lesions J Vasc Surg 21 549–557 Occurrence Handle1:STN:280:DyaK2M3it1OrtQ%3D%3D Occurrence Handle10.1016/S0741-5214(95)70186-9 Occurrence Handle7707560
JC Parodi JC Palmaz HD Barone (1991) ArticleTitleTransfemoral intraluminal graft implantation for abdominal aortic aneurysm Ann Vasc Surg 5 491–499 Occurrence Handle1:STN:280:DyaK387is1Cltw%3D%3D Occurrence Handle10.1007/BF02015271 Occurrence Handle1837729
Wakhloo AK, Tio FO, Lieber BB, et al (1995) Self-expandable nitinol stents in canine vertebral arteries: Hemodynamics and tissue response. AJNR Am J Neuroradiol 16:1043–1051
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Joo, J.Y., Ahn, J.Y., Chung, Y.S. et al. Treatment of Intra- and Extracranial Arterial Dissections Using Stents and Embolization. Cardiovasc Intervent Radiol 28, 595–602 (2005). https://doi.org/10.1007/s00270-004-0199-x
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DOI: https://doi.org/10.1007/s00270-004-0199-x