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Case series
Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach
  1. Fernando Delgado1,
  2. Isabel Bravo1,
  3. Elvira Jiménez1,
  4. Eduardo Murías2,
  5. Antonio Saiz3,
  6. Pedro Vega2,
  7. Antonio López-Rueda4,
  8. Jordi Blasco4,
  9. Juan Macho4,
  10. Alejandro González5
  1. 1Department of Interventional Neuroradiology, Reina Sofía University Hospital, Córdoba, Spain
  2. 2Department of Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain
  3. 3Department of Neuroradiology, Hospital Central de Asturias, Oviedo, Spain
  4. 4Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Spain
  5. 5Department of Radiology, Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain
  1. Correspondence to Dr Alejandro González, Department of Radiology, Interventional Neuroradiology, Virgen del Rocio University Hospital, Ave Manuel Siurot s/n, Seville 41013, Spain; ggjandro{at}gmail.com

Abstract

Background Carotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy.

Objective To evaluate the results of endovascular treatment and clinical outcomes of patients with CD.

Methods A four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8.

Results Thirty-eight patients (mean age 46.6±13.5 years, 78.9% male, 84.2% spontaneous CD, 44.7% left CD and 26.3% bilateral CD) were analyzed. In 24 patients (63.2%) treatment was undertaken in the acute-phase CD (APCD). IV recombinant tissue plasminogen activator was administered in 7 (29.2%) APCD cases. The patients with APCD exhibited a high rate of successful revascularization (Thrombolysis In Cerebral Infarction ≥2b; 19 patients (79.2%)), a low risk of symptomatic intracranial hemorrhage (n=2 (8.3%)), and good global functional outcomes (modified Rankin Scale (mRS) ≤2; n=17 (70.8%)). Good recanalization correlated (p=0.001) with good clinical evolution (mRS ≤2) in the patients with APCD. Of the 14 patients with non-acute phase CD (NAPCD), seven were treated for pseudoaneurysm with multiple stents (six patients) or covered prostheses, with stenosis being treated in the remaining seven patients.

Conclusions Endovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.

  • Stroke
  • Dissection

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