Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature

Pham, Martin H.; Rahme, Rudy J.; Arnaout, Omar; Hurley, Michael C.; Bernstein, Richard A.; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1227/neu.0b013e318209ce03

Cited by 157 publications

(112 citation statements)

References 81 publications

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“…Successful treatment has been reported as a result of the placement of a stent or other flow-diverting devices [18][19][20][21][22][23]. Although preservation of the parent artery is ideal, the durability of the perforating artery or the anterior spinal artery is not clear.…”

Section: Complications and Follow-upmentioning

confidence: 99%

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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2 Abstract PurposePrevious reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. MethodsA total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. ResultsForty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6%). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74%). Cranial nerve paresis (CNP) was observed in 6 patients (8.21%), spinal cord infarction in 2 patients(2.74%) and a perforating artery ischemia was diagnosed in 7 patients (9.59%); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. ConclusionsThe results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3months after tnitial treatment without rupture. CNP were observed in 8.21%, perforating ischemia in 9.59%, and spinal cord infarction in 2.74%. The former two are temporaly, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.

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Section: Complications and Follow-upmentioning

confidence: 99%

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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“…Actually, improvements in stent technology may expand the population that may be eligible for endovascular treatment [30]. The use of new hemostatic agent as FloSeal (Baxter Biosciences, Vienna, Austria) could provides a quick and effective method of hemostasis in the bleeding by VA injury [1].…”

Section: Managementmentioning

confidence: 99%

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases

Park

Jho

2012

Eur Spine J

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Purpose Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy. Methods Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications. Results Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications. Conclusion Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.

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“…As a result, he observed no severe complications during the operation and neither stroke nor de novo in-stent thrombosis/stenosis during a mean postoperative follow-up period of 28.7 ± 31.9 months. 11) Pham et al 12) performed meta-analysis in 140 patients in 31 studies on stenting for carotid artery dissection, and reported a technical success rate of stenting of 99%, procedural complication rate of 1.3%, mean postoperative follow-up period of 12.8 months, and in-stent stenosis or occlusion rate of 2%.…”

Section: Postoperative Coursementioning

confidence: 99%

Multiple Stenting for Extended Right Carotid Artery Dissection from Aortic Dissection via the Right Brachial Artery Approach: A Case Report

Moteki

Niimi

Inoue

et al. 2016

JNET

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Objective: We report a patient with symptomatic right carotid artery dissection due to extension from aortic dissection who underwent stenting via the right brachial artery approach.Case: A 61-year-old male underwent emergency operation for Stanford A type aortic dissection, but developed cerebral infarction due to extension of the dissection to the right carotid artery after the operation, and underwent stenting via the right brachial artery approach for the prevention of recurrence. A 6-Fr Simmons type Axcelguide was inserted, and stenting was performed with two Carotid Wallstents in conjunction with the Filterwire EZ. He showed a favorable postoperative course and was discharged home. Conclusion:When extension of dissection to the right subclavian artery is absent, stenting using the right radial artery approach should be considered as a safe procedure.

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Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature

Abstract: Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared with medical management are needed to further elucidate the role of stenting.

Cited by 157 publications

References 81 publications

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases

Multiple Stenting for Extended Right Carotid Artery Dissection from Aortic Dissection via the Right Brachial Artery Approach: A Case Report

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