Endovascular Treatment of Cervical Artery Dissection: Ten Case Reports and Review of the Literature

Abstract

Purpose: The role of endovascular treatment in cases of cervical artery dissection (CeAD) is debatable. With an increasing number of endovascular therapies such as endovascular recanalization and embolization the number of complications such as iatrogenic dissection is also rising. We report our experience with endovascular stenting in the treatment of patients presenting with CeAD. Methods: We included all consecutive patients with CeAD (n = 168) treated in our hospital between 2001 and 2010 for our retrospective study. Patients with CeAD were considered eligible for stenting: (1) in iatrogenic dissections and (2) in noniatrogenic dissections if they suffered from recurrent ischemic events despite antithrombotic treatment. Results: During our observation period 10 out of 168 patients presenting with CeAD were selected for stenting. Several types of stents were used. Stenting was technically successful in 8 but unsuccessful in 2 patients with complete arterial occlusion. Stent-related clinically apparent complications occurred in 3 of the 10 patients. All were transient. During a mean follow-up of 47 (±24.8) months none of the patients had new cerebrovascular ischemic events. Conclusion: In our patient sample stenting due to dissection is a rare procedure performed in less than 10% of CAD patients. It should be considered as a feasible rescue treatment in cases of impending stroke despite optimal antithrombotic therapy.

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

“…The published literature reflects small case series, individual case reports, and several systematic reviews. 326 A systematic review of the literature published until 2009 found 31 published reports (n=140) with a technical success rate of 99% and procedural complication rate of 1.3%. However, these observational data are prone to selection and reporting bias.…”

Endovascular management of internal carotid artery dissection with associated aneurysm using a multilayer flow modulator

“…1,13 Moreover, endovascular therapy is also recommended in patients with neurologic symptoms, such as headache, Horner syndrome, or thromboembolic events. [13][14][15] rate of 1.3%. 11 A systematic review of endovascular stenting of extracranial carotid artery with aneurysms, which included 258 aneurysms (240 pseudoaneurysms and 18 true aneurysms), confirmed the technical feasibility of the procedure with a success rate of 92.8% and low complication rate (1.8%).…”

“… 1 , 13 Moreover, endovascular therapy is also recommended in patients with neurologic symptoms, such as headache, Horner syndrome, or thromboembolic events. 13 , 14 , 15 …”

Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke

“…Observational studies have reported the use of endovascular treatment for patients with arterial dissection experiencing recurrent ischaemic symptoms despite receiving optimal medical treatment,8 and if the dissected artery presents with a pseudoaneurysm dilation 9. However, these studies involve extracranial artery dissections.…”