Recanalization of symptomatic carotid artery  dissections causing occlusion with multiple  stents: the use of delayed double-contrast road  map.
OBJECTIVE
Internal carotid artery dissections (ICADs) with occlusion present with a high morbidity and mortality. No specific medical treatment has proven to be effective in this setting. In selected cases of ICAD with occlusion, stent-assisted angioplasty has been shown to be effective in restoring the perfusion. Spontaneous ICAD causing occlusion successfully recanalized with multiple telescoped stents extending intracranially has only been reported exceptionally.


METHODS
We report cases of symptomatic acute carotid occlusion after spontaneous dissection extending from the cervical to the petrocavernous ICA segments. Imaging studies revealed the presence of an extensive penumbra area in every case. Patients were treated by means of multiple stents deployed in a telescoped fashion with the aid of a delayed double-contrast road map.


RESULTS
Post-procedural angiography demonstrated restitution of the carotid lumen with no signs of residual dissection or intracranial emboli. The patients improved rapidly, showing no residual neurological deficit after a week. At follow-up, patients are clinically asymptomatic and the vessel is patent with no radiological signs of myointimal hyperplasia.


CONCLUSIONS
The successful angiographic and clinical results observed in our cases of extraintracranial stenting of a long carotid dissection causing occlusion contribute to the literature of carotid dissection treated with multiple stents.
Cohen
José E
JE
Department of Neurosurgery, Hadassah University Medical Center, Jerusalem, Israel.
Gomori
John M
JM
Leker
Ronen R
RR
Ben-Hur
Tamir
T
Grigoriadis
Savvas
S
Rajz
Gustavo
G
D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D020215:Carotid Artery, Internal, Dissection / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000601:surgery
D003287:Contrast Media