Stent treatment for basilar artery dissection: A single-center experience of 21 patients

Abstract

<jats:p> Basilar artery dissection is a rare disease with high morbidity and mortality. No well-established management strategy exists for this lesion. Endovascular reconstructive therapy using stents (with or without coiling) may be the optimum strategy. </jats:p><jats:p> We describe our center’s experience for this treatment strategy in 21 patients with basilar artery dissection from January 2009 to July 2014 (17 men, four women; age range, 18–70 years; median age, 56 years). We divided patients into two groups: Group 1 patients received stent-assisted coiling treatment, and Group 2 patients received stent-only treatment. Pre-treatment, peri-operation and follow-up evaluation were investigated for complications, clinical outcome and angiographic results. The median follow-up time was 20 months (range, 3–67 months). </jats:p><jats:p> All patients were treated endovascularly by stent-assisted coiling (14 patients) or stent only (seven patients). Immediate angiography showed: in Group 1, five of 14 lesions were completely occluded, five were partially occluded, four revealed retention of contrast media; in Group 2, all patients (seven of seven) had contrast retention. At the follow-up visit (median seven months, 3–29 months), the aneurysms were angiographically improved in five of 13 patients in Group 1 compared with immediately post-operation, while six of sevenimproved in Group 2. Five patients (all in Group 1) had ischemic or hemorrhage peri-operation complications. Long-term good clinical outcomes (modified Rankin Scale score (mRS) ≤ 2) were achieved in all patients except three death cases (two in Group1, one in Group 2). </jats:p><jats:p> In our experience, endovascular reconstructive therapy using stents (with or without coiling) for basilar artery dissection is effective and safe. Stent-only treatment seems have a better safety profile during the peri-operation period. </jats:p>

Emergent stenting after intravenous thrombolysis for isolated basilar artery dissection in a patient with acute ischemic stroke: a case report

“…This is the first case report of a patient with acute ischemic stroke due to IBAD who underwent emergent stenting for neurological deterioration after IV-rtPA. Although some cases of stenting for IBAD have been reported, most of the procedures in these cases were performed after at least 3 days of dual antiplatelet therapy [2][3][4][5], and there is only one report of stenting in the hyper-acute phase of ischemic stroke [3]. There is no previous report of emergent stenting after IV-rtPA for IBAD-related ischemic stroke.…”

“…Isolated basilar artery (BA) dissection (IBAD) is a rare but important cause of ischemic stroke (incidence, 1/400,000/year) [ 1 ]. It is known to have a poor prognosis, with a mortality rate ranging from 10 to 78.9% [ 2 ]. Anti-thrombotic therapy is often used to treat IBAD-related ischemic stroke, but selected cases might need more aggressive treatment [ 3 ].…”

“…Anti-thrombotic therapy is often used to treat IBADrelated ischemic stroke, but selected cases might need more aggressive treatment [3]. Although some cases of endovascular stenting for IBAD have been reported, the procedures were performed electively for progressive ischemic symptoms despite adequate anti-thrombotic therapy [2][3][4][5]. To the best of our knowledge, there is no previous report of emergent stenting for IBAD-related ischemic stroke after intravenous thrombolysis.…”

Endovascular management of ruptured basilar artery dissection with two overlapping Low-profile Visualized Intraluminal Support stents

“…Stent-in-stent technique is an alternative strategy, which provides similar MCR and preservation of perforator flow when a flow diverter is not available or not suitable. 4 Furthermore, more than two stents could be used in the stent-in-stent technique, such as three overlapping stents. 5…”

Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

“…6 Endovascular treatment has been reported to be safe and effective in small series or case reports with or without stent placement, and initial complete occlusion was a favorable factor for stable follow-up and improved outcomes. [7][8][9][10] This report presented seven CADs, for which diagnosis and treatment are difficult, as source of subarachnoid hemorrhage (SAH).…”