Endovascular repair of extracranial carotid artery dissection: current status and level of evidence.
OBJECTIVE
To provide evidence for the endovascular repair of patients with extracranial carotid artery dissection.


METHODS
A comprehensive literature review was performed whereby all studies that reported on the results of endoluminal repair of extracranial carotid artery dissection and provided information about primary technical and clinical success were identified. The Pubmed, Embase, and Medline databases were searched between January 1997 and February 2008 by two independent observers by using combinations of search terms "endovascular repair," "extracranial carotid artery," and "carotid dissection."


RESULTS
After studies were selected according to the given criteria, 13 studies were included in our statistical analysis. The number of reported patients was 62, with a total of 63 extracranial carotid artery dissections. The mean patient age was 43.3 years. The mean follow-up period was 15.7 months +/- 8.7. Various causes were responsible for the disease, including a blunt neck injury in 28 patients (45%), spontaneous dissection in 21 (37%), and iatrogenic trauma during invasive radiologic procedure in 17.7% patients. The technical success rate was 100% (63 of 63 procedures). The primary and 1-year patency rate of the stents and/or stent-grafts was 100%. The overall major adverse cardiovascular events rate was 11% (seven strokes). The total follow-up mortality rate was 0%.


CONCLUSIONS
The current status of the reported cases in the literature regarding the treatment of carotid artery dissection by means of stent placement shows excellent early and 1-year patency rates and a low major adverse cardiovascular event rate. However, further evaluation is necessary to draw robust conclusions.
Clinic for Cardiovascular Surgery, Zurich University Hospital, Raemisstrasse 100, CH-8091 Zurich, Switzerland.
Konstantinos P
KP
Donas
Dieter
D
Mayer
Ivo
I
Guber
Ralf
R
Baumgartner
Michele
M
Genoni
Mario
M
Lachat
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D002318:Cardiovascular Diseases / Q000209:etiology; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult