Safety and outcome of mechanical thrombectomy in ischaemic stroke related to carotid artery dissection

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.

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Ischaemic stroke caused by spontaneous unilateral carotid artery dissection in patient with connective tissue disorder

Aktualności Neurologiczne ◽

10.15557/an.2021.0006 ◽

2021 ◽

Vol 21 (1) ◽

pp. 41-46

Author(s):

Weronika Pużyńska ◽

◽

Anna Mirończuk ◽

Katarzyna Kapica-Topczewska ◽

Adam Łukasiewicz ◽

...

Keyword(s):

Carotid Artery ◽

Connective Tissue ◽

Ischaemic Stroke ◽

Young Patients ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Left Internal Carotid Artery ◽

Cervical Artery Dissection ◽

Connective Tissue Disorders ◽

Ehlers Danlos Syndrome

Background: Spontaneous cervical artery dissection is a major cause of ischaemic stroke in young patients. It is supposed that genetic variants associated with connective tissue disorders often lead to neurovascular complications, the management of which remains a challenge. Case presentation: A 30-year-old female was admitted to the Department of Neurology with an episode of visual disturbances, speech problems, and concomitant headache. Computed tomography angiography revealed left internal carotid artery dissection. Magnetic resonance of the brain showed cortical and subcortical acute ischaemic lesions in the left cerebral hemisphere. The patient was diagnosed with vascular Ehlers–Danlos syndrome based on the clinical course of the disease. Conservative treatment was administered with full neurological recovery. Conclusion: It is very important for clinicians to consider the coexistence of genetically determined connective tissue disorders in young patients who develop arterial dissections.

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Endovascular Treatment of Stroke Caused by Carotid Artery Dissection

Brain Sciences ◽

10.3390/brainsci10110800 ◽

2020 ◽

Vol 10 (11) ◽

pp. 800

Author(s):

Grzegorz Meder ◽

Milena Świtońska ◽

Piotr Płeszka ◽

Violetta Palacz-Duda ◽

Dorota Dzianott-Pabijan ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Endovascular Treatment ◽

Small Proportion ◽

Mechanical Thrombectomy ◽

Carotid Artery Dissection ◽

Large Vessel ◽

Artery Dissection ◽

Large Vessel Occlusion ◽

Vessel Occlusion

Ischemic stroke due to large vessel occlusion (LVO) is a devastating condition. Most LVOs are embolic in nature. Arterial dissection is responsible for only a small proportion of LVOs, is specific in nature and poses some challenges in treatment. We describe 3 cases where patients with stroke caused by carotid artery dissection were treated with mechanical thrombectomy and extensive stenting with good outcome. We believe that mechanical thrombectomy and stenting is a treatment of choice in these cases.

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Running, ischaemic stroke and carotid artery dissection

QJM ◽

10.1093/qjmed/hcv089 ◽

2015 ◽

Vol 108 (12) ◽

pp. 973-974 ◽

Cited By ~ 1

Author(s):

N.R. Evans ◽

V. Harper ◽

D.J. Scoffings ◽

E.A. Warburton

Keyword(s):

Carotid Artery ◽

Ischaemic Stroke ◽

Carotid Artery Dissection ◽

Artery Dissection

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Ischaemic stroke due to traumatic carotid artery dissection

Pediatric Radiology ◽

10.1007/s002470050577 ◽

1999 ◽

Vol 29 (3) ◽

pp. 223-223

Author(s):

Imre Velkey ◽

Bela Lombay ◽

Zoltan Harkanyi

Keyword(s):

Carotid Artery ◽

Ischaemic Stroke ◽

Carotid Artery Dissection ◽

Artery Dissection

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Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke

BMJ Case Reports ◽

10.1136/bcr-2019-231612 ◽

2020 ◽

Vol 13 (1) ◽

pp. e231612

Author(s):

Laura Ludovica Gramegna ◽

Analía Cardozo ◽

Edgar Folleco ◽

Alejandro Tomasello

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Internal Carotid ◽

Flow Diverter ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Flow Diverter Stent

Intracranial carotid artery dissections are challenging, as there are no specific guidelines for their treatment, and most research suggests solutions for treating those involving extracranial vessels. We describe a patient with an acute ischaemic stroke within the territory of the right internal carotid artery, who was found to have intracranial carotid artery dissection during the thrombectomy procedure. The dissected lumen was successfully reconstructed via deployment of a Derivo flow-diverter stent. A balloon-assisted ‘jacking’ manoeuvre, in which a balloon is partially inflated at the beginning of the dissection to serve as leverage, was used to overcome the challenge of navigating the microcatheter tip through the stenosis proximal to the dissection. This case demonstrates the feasibly and safety of stenting with a flow diverter in a patient with internal carotid artery dissection; however, further studies are needed to confirm this finding.

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Safety and Feasibility of Reconstructing Dissection Tandem Lesions with Flow Diverter Stents during Mechanical Thrombectomy for Acute Ischemic Stroke: A Multicenter Retrospective Case Series

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.121.000122 ◽

2021 ◽

Author(s):

Humberto Diaz‐Silva ◽

Carlos Piñana ◽

Laura Ludovica Gramegna ◽

Manuel Requena ◽

Eila Rivera ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Case Series ◽

Flow Diverter ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Tandem Lesions

BACKGROUND Patients with acute ischemic stroke due to large vessel occlusion may present with concomitant carotid dissections that make the technical approach for their treatment challenging. The purpose of this study was to determine the safety and feasibility of flow diverter (FD) stents to treat carotid artery dissections in tandem lesions of acute ischemic stroke patients during mechanical thrombectomy. METHODS A retrospective review of all patients in which a carotid artery dissection was treated with an FD during endovascular treatment of acute ischemic stroke between 2018 and 2020 was conducted in 5 high‐volume Comprehensive Stroke Centers. Patient clinical and angiographical characteristics, postoperative outcome, and follow‐up were recorded. RESULTS A total of 12 patients (mean age: 54.18±14.74 years, median Alberta Stroke Program Early CT Score: 10 [interquartile range 9–10]) were included. Successful FD stenting with immediate patency of the dissected segments and successful intracranial recanalization modified thrombolysis in cerebral infarction score 2b‐3 after thrombectomy was achieved in all patients. A good outcome (modified Rankin scale 0–2 at 90 days) was achieved in 66% (8/12) of patients. In 25% (3/12) of patients, an additional self‐expanding carotid stent was used to anchor the FD proximally at the carotid bulb level. Complications included 1 symptomatic intracranial hemorrhage after procedure (24–48 hours) and 2 in‐stent stenoses at follow‐up. CONCLUSIONS In this small case series, the treatment of carotid artery dissection with FD stents was safe and technically feasible during mechanical thrombectomy of acute ischemic stroke patients with tandem lesions and resulted in a high rate of good clinical outcome. These results may provide the basis for designing larger prospective studies to assess the efficacy and safety of FD stents in selected patients with carotid tandem lesions.

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