title: Self-expanding stent placement for anterior circulation intracranial artery dissection presenting with ischemic symptoms.
abstract: BACKGROUND
  The prognosis of ischemic anterior circulation intracranial dissection (AC-ICD) is poor and its optimal management is still controversial.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of a self-expanding stent for ischemic AC-ICD.
  
  
  METHODS
  Eight patients (mean age, 36 years) underwent self-expanding stenting for ischemic AC-ICD. Imaging findings of ischemic AC-ICD, the reason for stenting, and the clinical and angiographic outcomes were retrospectively evaluated.
  
  
  RESULTS
  AC-ICD involved intracranial internal carotid artery to middle cerebral artery (MCA) in 2, intracranial internal carotid artery alone in 3, and MCA alone in 3 patients. Six AC-ICDs showed complete or near occlusions while 2 had a severe degree of stenosis. Six AC-ICDs showed an intimal flap and 3 had intramural hematomas. Six patients underwent emergent stenting for acute stroke within 6 hours (n=2) or crescendo-type stroke within 24 hours (n=4), while 2 patients had stenting for recurrent ischemia on dual antiplatelet and/or anticoagulation after the initial attack. The mean dissection-related stenosis improved from 93.1% to 20.3% after stenting (P<.05). The mean National Institutes of Health Stroke Scale score improved from 7.5 to 1.4 (P<.05). All patients had excellent or favorable outcomes at 3 months: modified Rankin Scale score, 0 in 3, 1 in 3, and 2 in 1 patient(s). No patients had subarachnoid hemorrhage or ischemic symptom recurrence during the clinical follow-up (mean, 27 months). All stented arteries were patent without significant in-stent stenosis on angiographic follow-up (range, 3-12 months).
  
  
  CONCLUSIONS
  Self-expanding stents seem to be safe and effective for AC-ICD presenting with acute/crescendo-type stroke or recurrent ischemia despite adequate medication.
authors.affiliation: *Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; ‡Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014481:United States