Endovascular treatment of acute internal carotid artery dissections

• Verfasst von: Kurre, Wiebke [VerfasserIn]
• Verfasst von: Bäzner, Hansjörg [VerfasserIn]
• Titel: Endovascular treatment of acute internal carotid artery dissections
• Titelzusatz: technical considerations, clinical and angiographic outcome
• Verf.angabe: Wiebke Kurre, Kai Bansemir, Marta Aguilar Pérez, Rosa Martinez Moreno, Elisabeth Schmid, Hansjörg Bäzner, Hans Henkes
• E-Jahr: 2016
• Jahr: 29 October 2016
• Umfang: 13 S.
• Fussnoten: Gesehen am 30.10.2019
• Titel Quelle: Enthalten in: Neuroradiology
• Ort Quelle: Berlin : Springer, 1970
• Jahr Quelle: 2016
• Band/Heft Quelle: 58(2016), 12, Seite 1167-1179
• ISSN Quelle: 1432-1920
• DOI: doi:10.1007/s00234-016-1757-z
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Acute stroke
• Sach-SW: Carotid artery
• Sach-SW: Dissection
• Sach-SW: Stent
• Sach-SW: Thrombectomy
• K10plus-PPN: 1680742906

Abstract

IntroductionIn 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.MethodsFrom 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.ResultsIn 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 %.ConclusionEVT 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.