title: Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome.
abstract: BACKGROUND
  In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet.
  
  
  METHODS
  From an institutional database, we retrospectively selected consecutive patients treated for a-ICAD between January 2007 and July 2015. We assessed recanalization results defining <50 % residual stenosis and mTICI ≥2b as successful. Procedural adverse events and symptomatic haemorrhages were reported as well as clinical outcome at 90 days defining a mRS ≤2 as favourable. Follow-up angiographies were reviewed and retreatments reported.
  
  
  RESULTS
  In the defined period, 73 patients (mean age 48 years (31-73), mean NIHSS 11 (0-27)) received EVT for a-ICAD. The majority (60 %) had tandem occlusions. Cervical artery reconstruction was successful in 100 % and intracranial thrombectomy in 85 %. Thrombus formation (18 %) and thromboembolism (20 %) were the most frequent adverse events but clinically relevant only in 8 %. Symptomatic haemorrhage occurred in 5 %. Clinical outcome was favourable in 64 %, with a lower chance after tandem occlusion (55 vs. 79 %, p = 0.047). Death rate was 10 %. None of the patients developed recurrent ischaemic symptoms, but control angiography revealed abnormal findings of the reconstructed ICA in 38 % leading to retreatment in 17 %.
  
  
  CONCLUSIONS
  EVT of a-ICAD is feasible with a predominantly favourable clinical outcome. Improvement of devices and techniques is warranted to reduce the risk of thrombus formation and thromboembolism during treatment and insufficient vessel wall healing thereafter.
authors: Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany. wiebke.kurre@gmx.de.|Institut für Neuroradiologie, Universitätsklinik Frankfurt, Goethe-Universität, Frankfurt, Germany. wiebke.kurre@gmx.de.
authors: Wiebke
authors: http://orcid.org/0000-0001-7748-9850
authors: W
authors: Kurre
authors: Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.|Klinik für Neurochirurgie, Klinikum Kempten, Kempten, Germany.
authors: Kai
authors: K
authors: Bansemir
authors: Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors: Marta
authors: M
authors: Aguilar Pérez
authors: Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors: Rosa
authors: R
authors: Martinez Moreno
authors: Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors: Elisabeth
authors: E
authors: Schmid
authors: Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
authors: Hansjörg
authors: H
authors: Bäzner
authors: Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.|Medizinische Fakultät, Universitätsklinik Duisburg-Essen, Essen, Germany.
authors: Hans
authors: H
authors: Henkes
mesh_terms: D000328:Adult; D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D015984:Causality; D000072226:Computed Tomography Angiography / Q000379:methods* / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality* / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Acute stroke; Carotid artery; Dissection; Stent; Thrombectomy