title: Long-term clinical and angiographic outcomes in patients with cervico-cranial dissections treated with stent placement: a meta-analysis of case series.
abstract: Limited clinical and angiographic data exists for patients with spontaneous or traumatic cervico-cranial dissections treated with stent placement. We reviewed clinical and angiographic data on consecutive patients admitted to our hospital with spontaneous, traumatic, and iatrogenic cervico-cranial dissections treated with stent placement to study immediate and long-term clinical and angiographic outcomes. Additional patients were identified using pertinent studies published between 1980 and 2009, using a search of the PubMed, Cochrane, and Ovid libraries. Post-procedure complications and clinical outcomes were documented. Angiographic abnormalities collected at follow-up included presence of in-stent restenosis or pseudoaneurysm. After applying our strict search criteria, four studies including our series were used in the meta-analysis, representing 46 patients (mean age [standard deviation] 47 ± 14 years; 24 [52%] male) treated with stent placement for dissection. Overall, 72 stents were placed to treat 28 spontaneous, 11 traumatic, and 7 iatrogenic dissection patients with 51 dissections, involving 51 vessels; with a mean pre-stent stenosis of 71 ± 26% and mean post-stent stenosis of 6 ± 15%. The immediate and follow-up post-procedure complication rates per stent placed was 8 (11%) and 8 (11%), respectively. Among the 36 patients who underwent follow-up angiography, in-stent restenosis or pseudoaneurysms were present in 3 (8%) and 2 (6%) patients, respectively. A high rate of sustained resolution of angiographic abnormalities during long-term follow-up was noted, with a low rate of new transient ischemic attack, ischemic stroke, or death, supporting the feasibility, safety, and effectiveness of endovascular stent reconstruction.
authors.affiliation: Zeenat Qureshi Stroke Research Center, Departments of Neurology, Neurosurgery, and Radiology, University of Minnesota, Minneapolis, Minnesota 55455, USA. ameerehassan@gmail.com
authors.forename: Ameer E
authors.initials: AE
authors.lastname: Hassan
authors.forename: Haralabos
authors.initials: H
authors.lastname: Zacharatos
authors.forename: Fotis
authors.initials: F
authors.lastname: Souslian
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000401:mortality*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000401:mortality; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D020214:Cerebrovascular Trauma / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents / Q000639:trends; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*