Carotid artery dissection: endovascular treatment. Report of 12 patients.
OBJECTIVE
The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents.


BACKGROUND
Carotid dissection is an important cause of ischemic stroke in young and middle-aged patients. There are some patients in whom invasive management is recommended.


METHODS
Twelve patients (eight females, four males), mean age of 50 years (range 35-80 years) with ICA dissection, were treated with the endovascular approach during a 24-month period. Patients included in this study underwent magnetic resonance (MR) and digital subtraction angiography (DSA) for diagnosis. Over this time period, 162 patients with ICA dissections were seen at our institution. Indications for endovascular treatment were: recurrent ischemic events despite adequate anticoagulant treatment in seven cases, contraindication to anticoagulation in four cases, and one case with significant mismatch between diffusion and perfusion weighted MR. Eleven dissections were spontaneous and one was traumatic. The follow-up was performed clinically with Doppler ultrasound (US) and MR at 6, 12, and 24 months.


RESULTS
Stent deployment was successful in all cases. Acute symptoms were resolved in 66.7% of patients. No patients deteriorated their neurological status. There were no new clinical events, stent stenosis or occlusion on 24 months follow-up.


CONCLUSIONS
Our results showed an excellent clinical outcome of the treated patients. This suggests promising results with the use of endovascular treatment in selected patients.
Fava
Mario
M
Interventional Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile. fava@med.puc.cl
Meneses
Luis
L
Loyola
Soledad
S
Tevah
Jose
J
Bertoni
Hernan
H
Huete
Isidro
I
Mellado
Patricio
P
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler