title: Endovascular Stenting for Symptomatic Carotid Dissection with Hemodynamic Insufficiency.
abstract: OBJECTIVE
  To date, no controlled studies on the treatment of carotid artery dissection (CAD) have been reported. The purpose of this study was to demonstrate the technical feasibility and clinical efficacy of stent-supported angioplasty (SSA) as primary treatment for acute stroke due to CAD.
  
  
  METHODS
  A review of medical records identified 21 patients who underwent SSA as primary treatment for acute stroke related to CAD between 2008 and 2014. The inclusion criteria were recent transient ischemic attack (n = 7, 33.3%) or acute infarct (n = 14, 66.7%) due to CAD (≥70% narrowing) with hemodynamic impairment. Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.
  
  
  RESULTS
  SSA was technically successful in all patients. Of 21 patients, 8 (38.1%) showed an additional intracranial occlusion. Intracranial recanalization to a thrombolysis in cerebral infarction ≥2b flow was achieved in 50% of the cases. Procedure-related mortality was 4.8%, and morbidity was 9.5%. Five (35.7%) of 14 patients presenting with an acute infarct showed significant improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 points compared with admission score) at 7 days after SSA. During the observation period (mean, 20.5 months), stroke recurrence occurred in only 1 patient (5%), resulting in an annual stroke risk of 2.9%. A favorable outcome (modified Rankin Scale score ≤2) was achieved in all 7 patients with a transient ischemic attack (100%) and in 7 of 14 patients with an acute infarct (50%) at the 90-day follow-up.
  
  
  CONCLUSIONS
  Our results provide evidence that SSA is a feasible and effective strategy as primary treatment for steno-occlusive CAD patients with significant hypoperfusion or a large penumbra.
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Youngsoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Chang Hwa
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Han Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Seung Kug
authors.initials: SK
authors.lastname: Baik
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea. Electronic address: redcheek09@naver.com.
authors.forename: Jun Kyeung
authors.initials: JK
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery
keywords: Angioplasty; Carotid artery; Dissection; Stents; Stroke