Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas, Konstantinos P.; Mayer, Dieter; Guber, Ivo; Baumgartner, Ralf W.; Genoni, Michele; Lachat, Mario

doi:10.1016/j.jvir.2008.08.025

Cited by 65 publications

(40 citation statements)

References 40 publications

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“…Relatively few reports have been published on a small number of patients with dissection. [264][265][266] These initial results provide some encouragement, with the development of new or progressive symptoms occurring infrequently. Endovascular therapies appear to provide significantly superior results compared with open surgical approaches, with lower stroke rates and no cranial nerve injuries.…”

Section: Carotid Dissectionmentioning

confidence: 90%

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Ricotta

AbuRahma

Ascher

et al. 2011

Journal of Vascular Surgery

569

536

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Management of carotid bifurcation stenosis is a cornerstone of stroke prevention and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008, the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time, only one randomized trial, comparing carotid endarterectomy (CEA) and carotid stenting (CAS), had been published. Since that publication, four major randomized trials comparing CEA and CAS have been published, and the role of medical management has been re-emphasized. The current publication updates and expands the 2008 guidelines with specific emphasis on six areas: imaging in identification and characterization of carotid stenosis, medical therapy (as stand-alone management and also in conjunction with intervention in patients with carotid bifurcation stenosis), risk stratification to select patients for appropriate interventional management (CEA or CAS), technical standards for performing CEA and CAS, the relative roles of CEA and CAS, and management of unusual conditions associated with extracranial carotid pathology. Recommendations are made using the GRADE (Grades of Recommendation Assessment, Development and Evaluation) system, as has been done with other Society for Vascular Surgery guideline documents.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be<3% to ensure benefit for the patient. CAS should be reserved for symptomatic patients with stenosis of 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as the first-line therapy.

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Section: Carotid Dissectionmentioning

confidence: 90%

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Ricotta

AbuRahma

Ascher

et al. 2011

Journal of Vascular Surgery

569

536

View full text Add to dashboard Cite

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“…3 In acute ICAD presenting with ischemic symptoms, most strokes or transient ischemic attacks are embolic in nature; therefore, they are mostly associated with good outcomes after administration of anticoagulation and/or antiplatelet medications. [5][6][7][8][9][10][11][12] Although stent placement for ICAD is both feasible and safe, 13 it is reserved for selected patients with ICAD with recurrent embolism refractory to medication, with contraindications for anticoagulation, or with persistent/enlarging pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…13,24 Therefore, delayed in-stent restenosis may not be a significant problem when treating ICA dissection by using stent-placement procedures.…”

Section: Discussionmentioning

confidence: 99%

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

Jeon¹,

Kim²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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“…Studies were included if they met the following criteria: (1) ICAD was diagnosed with the help of enhanced computed tomography, magnetic resonance imaging or angiography; (2) endovascular reconstruction was performed; (3) the lesion involved the internal carotid artery, including the extracranial carotid artery and intracranial carotid artery, and (4) the mean follow-up period was not less than 6 months [12]. Studies were excluded due to the following circumstances: (1) no outcome data or (2) use of thrombolytic therapy [12].…”

Section: Methodsmentioning

confidence: 99%

“…Studies were excluded due to the following circumstances: (1) no outcome data or (2) use of thrombolytic therapy [12]. …”

Section: Methodsmentioning

confidence: 99%

A Systematic Review of Endovascular Management of Internal Carotid Artery Dissections

Huang

Zhou²

2012

Intervent Neurol

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Background: We conducted a review of the safety and outcomes of endovascular intervention in patients with internal carotid artery dissection (ICAD). Summary: A literature review was performed. PubMed and Medline databases were searched from inception to September 2012 with the key words ‘carotid artery' (title), ‘dissection' (title) and ‘endovascular' (title/abstract). All studies were included which reported outcomes of endovascular intervention in ICAD and provided information about technical and clinical results. After screening, we included 23 articles. In total, 201 patients (128 male and 73 female) were included in the eligible studies. The mean age was 46.7 years (range 13-83 years). Of the 201 patients, the causes of the carotid dissections were traumatic in 69 (34.3%), spontaneous in 115 (57.2%) and iatrogenic in 17 (8.5%). The technical success rate was 99.1%. The overall rate of major cardiovascular events in the perioperative period was 4%. No procedure-related deaths occurred. Imaging follow-up data (mean follow-up time 16.5 months) demonstrated that only 3.3% of patients had intimal hyperplasia or in-stent restenosis or occlusion of a treated vessel. Clinical follow-up data (mean follow-up period 20.9 months) showed that only 2.1% of patients had a recurrent transient ischemic attack in the territory of the treated vessel. Key Messages: Endovascular intervention with stenting or stent-graft-supported angioplasty in selected patients with ICAD is promising. However, further evaluation is warranted to provide more evidence to support the feasibility of endovascular procedures in treating ICAD.

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Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Cited by 65 publications

References 40 publications

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

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

A Systematic Review of Endovascular Management of Internal Carotid Artery Dissections

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