Symptomatic spontaneous intracranial carotid artery dissection treated with a self-expanding intracranial nitinol stent: a case report.
BACKGROUND
Although extracranial carotid dissection with stroke is common, intracranial dissection with stroke is rare. Stenting has been used to treat extracranial carotid dissections. Intracranially, however, it is only recently that stents have become a feasible option for this disease. We present a case of a spontaneous intracranial CAD with progressive symptoms despite medical management treated with a self-expanding intracranial micronitinol stent.


METHODS
A 47-year-old, right-handed woman presented to the emergency department after noticing left-sided face and arm weakness and numbness, along with slurred speech. The patient was started on aspirin 325 mg/d orally and lovenox 40 mg/d subcutaneously. On hospital day 2, the patient was noted to have repeated episodes of weakness and numbness on the left side and MRI evidence of a new stroke. A diagnostic cerebral angiogram from a selective right internal carotid injection revealed a flow-limiting stenosis secondary to a dissection of the supraclinoid internal carotid artery with severe flow limitation to the hemisphere. Endovascular management was decided on, and a Neuroform stent measuring 4.5 x 20 mm (Boston Scientific Corporation, Natick, Mass) was deployed across the dissection with significant improvement of flow to that hemisphere on the poststent angiogram.


CONCLUSIONS
This case illustrates the successful off-label use of a self-expanding intracranial nitinol stent to treat a symptomatic intracranial internal CAD in the setting of failure of traditional medical management. This is a promising application of novel endovascular technology.
Surdell
Daniel L
DL
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Bernstein
Richard A
RA
Hage
Ziad A
ZA
Batjer
H Hunt
HH
Bendok
Bernard R
BR
D000497:Alloys / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation* / Q000379:methods
D000497:Alloys; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; C013616:nitinol