title: Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach.
abstract: BACKGROUND
  Carotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy.
  
  
  OBJECTIVE
  To evaluate the results of endovascular treatment and clinical outcomes of patients with CD.
  
  
  METHODS
  A four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8.
  
  
  RESULTS
  Thirty-eight patients (mean age 46.6±13.5 years, 78.9% male, 84.2% spontaneous CD, 44.7% left CD and 26.3% bilateral CD) were analyzed. In 24 patients (63.2%) treatment was undertaken in the acute-phase CD (APCD). IV recombinant tissue plasminogen activator was administered in 7 (29.2%) APCD cases. The patients with APCD exhibited a high rate of successful revascularization (Thrombolysis In Cerebral Infarction ≥2b; 19 patients (79.2%)), a low risk of symptomatic intracranial hemorrhage (n=2 (8.3%)), and good global functional outcomes (modified Rankin Scale (mRS) ≤2; n=17 (70.8%)). Good recanalization correlated (p=0.001) with good clinical evolution (mRS ≤2) in the patients with APCD. Of the 14 patients with non-acute phase CD (NAPCD), seven were treated for pseudoaneurysm with multiple stents (six patients) or covered prostheses, with stenosis being treated in the remaining seven patients.
  
  
  CONCLUSIONS
  Endovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.
authors.affiliation: Department of Interventional Neuroradiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Delgado
authors.affiliation: Department of Interventional Neuroradiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Bravo
authors.affiliation: Department of Interventional Neuroradiology, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Elvira
authors.initials: E
authors.lastname: Jiménez
authors.affiliation: Department of Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Murías
authors.affiliation: Department of Neuroradiology, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Saiz
authors.affiliation: Department of Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Vega
authors.affiliation: Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Rueda
authors.affiliation: Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Blasco
authors.affiliation: Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macho
authors.affiliation: Department of Radiology, Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: González
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Dissection; Stroke