Endovascular reconstruction of internal carotid artery dissection in patients with acute ischemic stroke using the Wingspan stent

Quintana, Eduardo; Valdés, P. Vega; Deza, Edison Morales; García, A. López; Saenz, Hugo Cuellar; Bernal, A. L. Salgado; Cadenas, María; Fernández, Lorena Benavente; Delgado, Montserrat González; Pérez, Nuria Riesco; Larrosa, Davinia; Calleja, Sergio

doi:10.1177/1591019916663470

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Several recent reports showed the usefulness of catheter intervention for the treatment of the carotid artery dissection, 4–10 with stent placement being the most frequent procedure. During stent placement, one of the most important steps is to cross the lesion using a micro guidewire, which should be kept inside the true lumen in order to place back the intimal flap to the vessel wall (Figure 5(b) and (c)).…”

Section: Discussionmentioning

confidence: 99%

“…Carotid artery dissection, which can cause occlusion or severe stenosis of the internal carotid artery (ICA), is one of the major causes of ischemic stroke in the young 1–3 and is currently usually treated by catheter intervention. 4–10 Although endovascular treatment is effective, passing the guidewire through the occlusion (lesion-cross) and confirmation of the true lumen, especially on the distal end of the lesion, can be difficult in some cases.…”

Section: Introductionmentioning

confidence: 99%

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A novel technique to visualize true lumen in endovascular treatment of the occlusive carotid dissection and the usefulness of external–internal carotid collateral channel

et al. 2018

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Background Dissection of the internal carotid artery (ICA) can cause occlusion or severe stenosis and is known to be one of the major causes of ischemic stroke in the young. Endovascular treatment is one of the useful options for carotid dissections, but passing the guidewire through the occlusion (lesion-cross) and confirmation of the true lumen are sometimes difficult. Case presentation A 40-year-old right-handed man complaining of dysarthria and gait disturbance consulted our hospital. Magnetic resonance imaging and angiography revealed right ICA dissection. Because of worsening symptoms with conservative treatment, we performed endovascular treatment. Prior to the lesion-cross, a microcatheter was navigated to the third segment of the internal maxillary artery and a balloon-guiding catheter was navigated to the proximal ICA. Under balloon occlusion of the ICA, superselective angiography via the ipsilateral maxillary artery and slow evacuation from the balloon-guiding catheter were performed. Thereafter, the course of the true lumen was clearly visualized, and we were able to navigate another microcatheter without difficulty. Subsequently, angioplasty and stent placement were successfully accomplished. Conclusion We presented a case of ICA dissection and demonstrated a novel technique for a safe lesion-cross for occlusive ICA dissection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel technique to visualize true lumen in endovascular treatment of the occlusive carotid dissection and the usefulness of external–internal carotid collateral channel

et al. 2018

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“…A variety of techniques have been described for carotid revascularization in this setting, including the use of dedicated carotid artery stents with or without balloon angioplasty [2, 9, 10], the use of self-expanding intracranial or peripheral stents [11-13], and the use of an overlapping or telescoping stenting technique [9]. Recently, Murias Quintana et al [3] called attention to the importance of considering ectatic or tortuous ICA anatomy that could impact the choice of carotid revascularization technique.…”

Section: Discussionmentioning

confidence: 99%

“…Anatomical tortuosity of the cervical ICA presents a technical challenge for conventional carotid stents, and there is limited experience with the use of intracranial or peripheral stents in this setting [3]. To the best of our knowledge, stenting around a true 360° tonsillar loop of the dissected ICA has not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

et al. 2018

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Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.

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“…However, it is a common cause of stroke in younger patients, estimated to account for 10% to 20% of cases. 1,2 In 1997, Matsuura et al. reported the first patient treated with endovascular stent-mediated repair of acute ICA dissection.…”

Section: Introductionmentioning

confidence: 99%

Endovascular repair of an acute symptomatic carotid artery dissection through the false dissecting carotid lumen

2018

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A 48-year-old woman presented with an acute ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) 21) six hours after symptom onset. Workup revealed a left cervical internal carotid artery (ICA) occlusive dissection, which was emergently reconstructed with a flow-diverting stent. A routine Duplex scan one hour later suggested reocclusion of the ICA, confirmed by angiography. The true lumen of the ICA could not be accessed and therefore the “false lumen” of the ICA dissection was entered proximally. The true lumen and ultimately the flow-diverting stent were accessed via the false lumen. In analogy to the subintimal arterial flossing with antegrade-retrograde intervention technique described for peripheral vascular disease, several stents were placed in telescoping fashion from the true common carotid lumen through the “false dissecting” lumen of the proximal ICA into the distal true lumen. The stent construct remained patent, and the patient recovered clinically to an NIHSS of 1.

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Endovascular reconstruction of internal carotid artery dissection in patients with acute ischemic stroke using the Wingspan stent

Cited by 8 publications

References 12 publications

A novel technique to visualize true lumen in endovascular treatment of the occlusive carotid dissection and the usefulness of external–internal carotid collateral channel

A novel technique to visualize true lumen in endovascular treatment of the occlusive carotid dissection and the usefulness of external–internal carotid collateral channel

Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

Endovascular repair of an acute symptomatic carotid artery dissection through the false dissecting carotid lumen

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