Comprehensive analysis of intra-arterial treatment for acute ischemic stroke due to cervical artery dissection

Jensen, Judd; Salottolo, Kristin; Frei, Donald; Loy, David; McCarthy, Kathryn; Wagner, Jeffrey C.; Whaley, Michelle; Bellon, Richard; Bar‐Or, David

doi:10.1136/neurintsurg-2016-012421

Cited by 25 publications

(30 citation statements)

References 36 publications

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“…In fact, other reports on EVT in CAD-related AIS with mTICI 2b-3 more than 80% had better clinical outcomes than our series. [13][14][15] This is consistent with previous studies reporting a clear relation between early recanalization and good clinical outcome. 31 Finally, EVT patients had a lower median (pc-)ASPECTS on admission CT than the other groups.…”

Section: Discussionsupporting

confidence: 92%

“…12 There are limited data available on EVT in AIS due to CAD from case series and observational studies. [13][14][15][16][17][18][19][20][21][22][23][24] Haussen et al collected 21 CAD-related AIS treated by EVT and compared them to 133 IVT patients pooled from previous studies in the literature. 14 Jensen et al published a retrospective single-center study that included 161 patients with stroke and CAD, 24 treated with mechanical thrombectomy and 137 with medical therapy (in this second group, only 11 received IVT).…”

Section: Introductionmentioning

confidence: 99%

“…14 Jensen et al published a retrospective single-center study that included 161 patients with stroke and CAD, 24 treated with mechanical thrombectomy and 137 with medical therapy (in this second group, only 11 received IVT). 15 Finally, Traenka et al analyzed 62 patients with CAD-related stroke, 24 treated with IVT and 38 with EVT. 17 These studies showed no significant difference in the outcome of patients undergoing EVT compared to other groups.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series

Bernardo

Nannoni

Strambo

et al. 2019

International Journal of Stroke

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Background: Limited observational data are available on endovascular treatment in acute ischemic stroke due to cervical artery dissection. Three studies comparing endovascular treatment with standard medical therapy or intravenous thrombolysis in cervical artery dissection-related acute ischemic stroke did not demonstrate superiority of endovascular treatment. Efficacy and the choice of endovascular treatment technique in this setting remain to be established. Aims: To assess the potential efficacy and safety of endovascular treatment compared to intravenous thrombolysis alone or to no revascularization treatment in our center. Methods: We selected all consecutive patients with cervical artery dissection-related acute ischemic stroke and intracranial occlusion from the Acute STroke Registry and Analysis of Lausanne between 2003 and 2017. We compared clinical and neuroimaging data of patients treated by endovascular treatment versus patients receiving intravenous thrombolysis or patients without revascularization treatment. Safety analysis included symptomatic intracranial hemorrhage, major radiological hemorrhages (parenchymal hematoma 1, parenchymal hematoma 2, and subarachnoid hemorrhage) and mortality within seven days. We assessed favorable clinical outcome (modified Rankin Scale 0-2) at three months using a binary logistic regression model. Results: Of the 109 patients included, 24 had endovascular treatment, 38 received intravenous thrombolysis alone, and 47 had no revascularization treatment. Endovascular treatment patients had a higher rate of recanalization at 24 h. Major radiological hemorrhages occurred more often in endovascular treatment patients (all with bridging therapy) than in patients without revascularization treatment (p ¼ 0.026), with no differences in symptomatic intracranial hemorrhage or mortality within seven days. Favorable clinical outcome at three months did not differ between groups (endovascular treatment versus intravenous thrombolysis p ¼ 0.407; endovascular treatment versus no revascularization treatment p ¼ 0.580). Conclusions: In this single-center cohort of cervical artery dissection-related acute ischemic stroke with intracranial occlusion, endovascular treatment with prior intravenous thrombolysis may increase the risk of major radiological but not symptomatic intracranial hemorrhage. Despite the lack of clear superiority in our cohort, endovascular treatment should currently not be withheld in these patients.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series

Bernardo

Nannoni

Strambo

et al. 2019

International Journal of Stroke

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“…Many studies reported endovascular treatment for cerebral ischemia caused by embolism derived from cervical ICA dissection. 7,8) According to a review published by Hoving et al, the results of recanalization therapy to treat embolic intracranial arterial occlusion were favorable. 2) There have been only a few case reports on intracranial arterial occlusion related to intracranial ICA dissection.…”

Section: Disclosure Statementmentioning

confidence: 99%

A Case of Internal Carotid Artery Dissection Presenting Acute Intracranial Occlusion and Accompanied with Simultaneous Carotid Cavernous Fistula Treated by Thrombectomy

Yamanouchi

Matsubara

Kanamori

et al. 2018

JNET

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Objective: We report a case of internal carotid artery (ICA) dissection presenting acute intracranial occlusion and accompanied with simultaneous carotid cavernous fistula (CCF) treated by thrombectomy.Case Presentation: The patient was a 43-year-old male who presented with severe neurological symptoms. Imaging findings demonstrated acute ischemic stroke with occlusion of the left ICA. A retrospective review of angiogram showed ICA dissection-related occlusion with a fine CCF. However, dissection could not be recognized initially, and thrombus aspiration with Penumbra system was performed as revascularization therapy. Recanalization of the ICA was not achieved and the CCF deteriorated. Considering the risk of hemorrhagic complications and the treatment of CCF, parent artery occlusion of the ICA was conducted. The CCF disappeared; however, an extensive area of the left middle cerebral artery territory was infarcted. Conclusion:In revascularization for acute ischemic stroke, it is important to adequately evaluate the condition such as dissection and to select an appropriate therapeutic strategy.

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“…Antiplatelets or anticoagulants are usually recommended to prevent primary or recurrent ischemic events. However, surgical or endovascular treatments may be used in patients with persistent symptoms of ischemia despite optimum medical treatment, or subarachnoid hemorrhage [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

Chen

Xing

et al. 2020

BMC Neurol

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Background Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. Methods All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. Results A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). Conclusions The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.

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Comprehensive analysis of intra-arterial treatment for acute ischemic stroke due to cervical artery dissection

Cited by 25 publications

References 36 publications

Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series

Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series

A Case of Internal Carotid Artery Dissection Presenting Acute Intracranial Occlusion and Accompanied with Simultaneous Carotid Cavernous Fistula Treated by Thrombectomy

Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

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