Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection.
BACKGROUND
Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents.


METHODS
A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator.


RESULTS
Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS < or = 1.


CONCLUSIONS
Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection.
Mourand
Isabelle
I
Department of Neurology, CHU Montpellier, Hôpital Gui de Chauliac, 34295 Montpellier, Cedex 5, France. i-mourand@chu-montpellier.fr
Brunel
Herve
H
Vendrell
Jean-François
JF
Thouvenot
Eric
E
Bonafé
Alain
A
D000208:Acute Disease / Q000628:therapy; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000473:pathology / Q000601:surgery / Q000628:therapy; D015912:Thrombolytic Therapy / Q000295:instrumentation* / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator