Treatment of intra- and extracranial arterial dissections using stents and embolization.
OBJECTIVE
To evaluate the safety and efficacy of stent placement for extracranial and intracranial arterial dissections.


METHODS
Eighteen patients underwent endovascular treatment of carotid and vertebral dissections using intraluminal stent placement. Five patients with arterial dissection were treated, 2 using one insertion of a single stent and 3 using placement of two stents. Patients with a dissecting aneurysm were treated as follows: 7 patients with insertion of one stent, 4 with placement of two stents, and 2 by stent-assisted Guglielmi detachable coil embolization. In the 18 patients in whom stenting was attempted, the overall success in reaching the target lesion was 94.4%. Of the 17 patients treated with stents, stent release and positioning were considered optimal in 16 (94%) and suboptimal in one (6%). In patients who underwent a successful procedure, all parent arteries were preserved. There were no instances of postprocedural ischemic attacks, new neurologic deficits, or new minor or major strokes prior to patient discharge. In follow up, all patients were assessed, using the modified Rankin scale, as functionally improved or of stable clinical status. The reduction in dissection-induced stenosis or pseudoaneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischemic or hemorrhagic) suggest that stent placement offers a viable alternative to complex surgical bypass or reconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remain to be determined in a larger series.
Joo
Jin Yang
JY
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea.
Ahn
Jung Yong
JY
Chung
Young Sun
YS
Han
In Bo
IB
Chung
Sang Sup
SS
Yoon
Pyeong Ho
PH
Kim
Sang Heum
SH
Choi
Eun Wan
EW
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000792:Angiography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D007723:Korea; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*