Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency

Abstract

BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.

Two Cases of Intracranial Internal Carotid Artery Dissection Presenting with Ischemic Stroke

“…In Case 1, since ischemic symptoms were exacerbated during the internal carotid artery. 12,15) In addition, as there has been no report of subsequent occurrence of subarachnoid hemorrhage in patients with successful stent placement, stenting may exert a preventive effect against subarachnoid hemorrhage by occluding the false lumen. A balloon-dilation type stent for the coronary artery was used in previous reports, but a self-expanding stent for aneurysmal coil embolization is often used in recent reports.…”

“…3,10,11,13) Surgical treatments are considered acceptable in patients who show progression of symptoms by medical treatment alone. 2,12,15) Regarding surgical treatments in the acute period, endovascular treatment using a stent, an approach conducted by ours, has often been reported recently. 11,12,14,15) However, stent placement for internal carotid artery dissection is an uninsured procedure, so it must be performed carefully with sufficient informed consent.…”

“…2,12,15) Regarding surgical treatments in the acute period, endovascular treatment using a stent, an approach conducted by ours, has often been reported recently. 11,12,14,15) However, stent placement for internal carotid artery dissection is an uninsured procedure, so it must be performed carefully with sufficient informed consent. Stent placement prevents thromboembolism by stabilizing the dissected vascular wall and alleviates hemodynamic ischemic symptoms by securing the antegrade blood flow and recanalizing of the simply by placing a self-expanding stent with a mild expansion force.…”

“…[2][3][4][5][6][9][10][11][12][13][14][15] Concerning internal treatments, indications of antithrombotic treatment still remain controversial. 1,3,4) Although there have been reports that antithrombotic therapy should be avoided, because there is a risk, although rare, of subarachnoid hemorrhage even in intracranial internal carotid artery dissection presenting with ischemia, there have also been reports that no subarachnoid hemorrhage was observed during the period of anticoagulation therapy.…”

“…5D). 15 O-gas positron emission tomography (PET) performed 2 days after the onset showed no decrease in the cerebral blood flow (CBF) or increase in the oxygen extraction fraction (OEF), and there was no sign of misery perfusion. Neurological symptoms were alleviated 8 days after the onset, and the NIHSS score became 0.…”