title: Intentional subintimal carotid stenting of internal carotid dissection in a patient with acute ischaemic stroke.
abstract: Carotid artery dissection is a common cause of juvenile stroke. Endovascular treatment of acute stroke due to carotid dissection can be challenging, and endoluminal crossing of the dissection is sometimes impossible. We describe a case of intentional subintimal recanalisation of a cervical carotid dissection followed by intracranial thrombectomy and stenting. We report the case of a young woman with severe acute ischaemic stroke due to carotid artery dissection and intracranial embolism. After failure of endoluminal crossing of the dissected segment, intentional subintimal crossing with re-entry distally to the dissection was achieved and a stent was deployed. Then, middle cerebral artery thrombectomy was performed achieving good recanalisation. Acute thrombus formed in the bulged segment of the carotid stent and was managed with additional stent placement. The patient had a good clinical recovery. In selected cases, after failure of conventional techniques, subintimal recanalisation of carotid dissections may be performed.
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Nicola
authors: N
authors: Limbucci
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Sergio
authors: S
authors: Nappini
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Andrea
authors: A
authors: Rosi
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Leonardo
authors: L
authors: Renieri
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Arturo
authors: A
authors: Consoli
authors: Interventional Neuroradiology Unit, Careggi University Hospital, Italy.
authors: Salvatore
authors: S
authors: Mangiafico
mesh_terms: D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D017131:Thrombectomy
keywords: Stroke; carotid dissection; stenting; subintimal