Surgical and radiological interventions for treating symptomatic extracranial cervical artery dissection

Hynes, Niamh; Kavanagh, Edel P; Sultan, Sherif; Jordan, Fionnuala

doi:10.1002/14651858.cd013118.pub2

Cited by 7 publications

(7 citation statements)

References 74 publications

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“…Therefore, the management of patients with initial symptoms of stroke should be more cautious. Until recently, there is no strong evidence to support the indications, efficacy, and safety of surgical or endovascular treatment in patients with sCAD after the failure of conservative treatment 2 . According to the 2011 guidelines for the management of extracranial carotid and vertebral artery diseases from the Society of Vascular Surgery, surgical or endovascular treatment may be considered after failure of conservative treatment, and EVT is generally considered better than open surgery 27 .…”

Section: Discussionmentioning

confidence: 99%

“…Carotid artery dissections (CAD) are a rare cause of stroke, accounting for about 2.5% of all stroke patients 1 , but it is the main cause of stroke in middle-aged and young people, which accounts for 8-25% of the causes of ischemic stroke in people under 45 years old 2, 3 . More than 90% of CAD is spontaneous carotid artery dissections (sCAD), which occur spontaneously or are secondary to minor trauma, such as neck massage, weightlifting, yoga, and severe cough 4 .…”

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confidence: 99%

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Classification and management strategy of spontaneous carotid artery dissection

Zhou,

Li,

Jiao

et al. 2023

Preprint

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Background and Purpose—Spontaneous carotid artery dissections (sCAD) are the main cause of stroke in young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 sCAD patients and proposed a new classification for sCAD with prognostic and therapeutic significance. Methods—This is a retrospective review of prospectively collected data from June 2018 to June 2023 of sCAD patients treated at a large tertiary academic institution in an urban city in China. Depending on the degree of luminal narrowing and pseudoaneurysm formation on imaging, sCAD was classified into four types. Type IV dissections were divided into type IVA and type IVB dissections according to the presence of intracranial occlusion. Results—A total of 179 patients and 197 dissected arteries met the inclusion criteria. More than two-thirds of type I dissections are completely recanalized after antithrombotic therapy, and only one case (1.8%) had recurrent ischemic stroke. A total of 38 % of type II dissections and 73% of type III dissections received endovascular treatment (EVT) for persistent flow-limited dissections, enlargement of pseudoaneurysm, or aggravation of clinical symptoms despite antithrombotic therapy. Type IV dissections are more likely to lead to the occurrence of ischemic stroke, and presented with more severe symptoms. About 33% of type IVB dissections received emergent intervention due to intracranial occlusion or aggravation of symptoms after medical treatment. Conclusions—This study proposes a novel and more comprehensive classification method and management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD like type I. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA. Urgent procedure with neurovascular intervention might be needed in those with type IVB SCAD. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcome should be elucidated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Classification and management strategy of spontaneous carotid artery dissection

Zhou,

Li,

Jiao

et al. 2023

Preprint

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“…Evidence of the superiority of either antiplatelet therapy or anticoagulation therapy is lacking at present. 15 , 16 ) In CAD patients with hemodynamic impairment presenting as progressive stroke or recurrent ischemic symptoms, despite adequate medical treatment, surgical reconstruction should be considered. 16 , 17 ) Hemodynamic impairment is well detected on perfusion images.…”

Section: Discussionmentioning

confidence: 99%

Urgent Carotid Artery Stenting with Intracranial and Carotid Stent for Symptomatic Bilateral Consecutive Internal Carotid Artery Dissection: A Case Report

TAKANO

Ishikawa

Funatsu

et al. 2022

NMC Case Report Journal

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Spontaneous internal carotid artery dissection (CAD) is a relatively rare disease, with patients, including those with bilateral CAD, often recovering after conservative therapy. However, patients with symptomatic and progressive disease require urgent carotid artery stenting (CAS). If CAD extends to the petrous portion of the internal carotid artery (ICA), it is difficult to treat with a carotid stent alone. This report describes a rare case of consecutive spontaneous bilateral CAD that required an intracranial stent with an interval of 4 years between the first and second CAS. A 58-year-old man with a history of dyslipidemia was admitted for transient ischemic attacks. He underwent CAS with carotid and intracranial stents on the third day for the left CAD due to exacerbation of symptoms under antithrombotic therapy and new stroke on magnetic resonance imaging (MRI). He recovered well. However, 4 years after the initial treatment, the patient was admitted again because of a sudden headache, photophobia, and transient weakness of the left lower limb. He was diagnosed with CAD on the contralateral side. He underwent CAS with carotid and intracranial stents due to progressive neurological deterioration under antithrombotic therapy. After treatment, he was clinically stable without any new infarctions on a follow-up MRI. He was discharged without neurological deficit. Our case of bilateral internal CAD treatment demonstrated that early revascularization with immediate stenting with carotid and intracranial stents in CAD contributes to the prevention of extensive neurological damage, thereby providing a favorable outcome in some cases.

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“…One of the most common causes of ischemic stroke in the young is carotid and vertebral artery dissection [ 1 – 4 ], conjunctly termed cervical artery dissection. Patients can present with headache or neck pain in the majority of cases, as well as with focal neurologic deficits, potentially referrable to either involvement damage sympathetic fibers or involvement of the brain parenchyma secondary to ischemia.…”

Section: Cervical Arterial Dissectionmentioning

confidence: 99%

“…The dissection can extent to the intracranial compartment and can be complicated by the presence of intramural thrombus and dissecting pseudoaneurysm. Imaging may reveal a near occlusion with true vessel lumen collapse and hemodynamic impairment, although most ischemia is thought to result from embolic phenomenon [ 4 – 6 ].…”

Section: Cervical Arterial Dissectionmentioning

confidence: 99%

Advances in Management of the Stroke Etiology One-Percenters

Osteraas

Dafer

2023

Curr Neurol Neurosci Rep

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Purpose of Review Uncommon causes of stroke merit specific attention; when clinicians have less common etiologies of stoke in mind, the diagnosis may come more easily. This is key, as optimal management will in many cases differs significantly from “standard” care. Recent Findings Randomized controlled trials (RCT) on the best medical therapy in the treatment of cervical artery dissection (CeAD) have demonstrated low rates of ischemia with both antiplatelet and vitamin K antagonism. RCT evidence supports the use of anticoagulation with vitamin K antagonism in “high-risk” patients with antiphospholipid antibody syndrome (APLAS), and there is new evidence supporting the utilization of direct oral anticoagulation in malignancy-associated thrombosis. Migraine with aura has been more conclusively linked not only with increased risk of ischemic and hemorrhagic stroke, but also with cardiovascular mortality. Recent literature has surprisingly not provided support the utilization of l -arginine in the treatment of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); however, there is evidence at this time that support use of enzyme replacement in patients with Fabry disease. Additional triggers for reversible cerebral vasoconstriction syndrome (RCVS) have been identified, such as capsaicin. Imaging of cerebral blood vessel walls utilizing contrast-enhanced MRA is an emerging modality that may ultimately prove to be very useful in the evaluation of patients with uncommon causes of stroke. A plethora of associations between cerebrovascular disease and COVID-19 have been described. Where pertinent, authors provide additional tips and guidance. Summary Less commonly encountered conditions with updates in diagnosis, and management along with clinical tips are reviewed.

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Surgical and radiological interventions for treating symptomatic extracranial cervical artery dissection

Cited by 7 publications

References 74 publications

Classification and management strategy of spontaneous carotid artery dissection

Classification and management strategy of spontaneous carotid artery dissection

Urgent Carotid Artery Stenting with Intracranial and Carotid Stent for Symptomatic Bilateral Consecutive Internal Carotid Artery Dissection: A Case Report

Advances in Management of the Stroke Etiology One-Percenters

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