Early Multicenter Experience With the Neuroform Atlas Stent: Feasibility, Safety, and Efficacy

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. E321-E335 ◽  
Author(s):  
Ahmad Sweid ◽  
Nabeel Herial ◽  
Kalyan Sajja ◽  
Nohra Chalouhi ◽  
Lohit Velagapudi ◽  
...  
Keyword(s):  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Intracranial Stenting ◽  
Complex Aneurysms ◽  
Major Complications ◽  
Number Of Patients ◽  
Acute Rupture ◽  
Favorable Clinical Outcome ◽  
Retrospective Multicenter Study

Abstract BACKGROUND The Neuroform Atlas stent™ (by Stryker, Fremont, California) represents the most recent widely available upgrade to intracranial stenting, providing a laser cut open cell stent with a diameter of 3.0 to 4.5 mm that is delivered through an 0.017-inch microcatheter. OBJECTIVE To report our initial multicenter experience of the safety, efficacy, and feasibility of the Atlas stent used for treating aneurysms, as well as one case of intracranial stenosis and one carotid artery dissection as well as other pathologies. METHODS A retrospective multicenter study of subjects treated with Atlas stent during the period 2018 to 2019. RESULTS The total number of patients included in our analysis was 71 patients. The stent was utilized to treat 69 aneurysm cases. Of the aneurysms, 36% presented with acute rupture and 56% of the ruptured aneurysms were high grade. Mean aneurysm dimension was 7 mm with an average neck width of 4.1 mm. Around 30% had received prior treatment. Telescoping or Y-stent was used in 16% of cases. We did not observe any symptomatic major complications in our series. Asymptomatic major complications were seen in 7 patients (10.1%); technical complications occurred in 4.3%. Immediate modified Raymond-Roy-occlusion-outcome class I/II was observed in 87%, and this increased to 97.7% at latest follow-up, which was at 4 mo; 91.8% of patients achieved favorable clinical outcome, and mortality rate was 1.4%. CONCLUSION Our series demonstrates the safety, feasibility, and efficacy of the Atlas stent. The low complication rate and the high obliteration rate managing complex aneurysms, even in an acute ruptured setting, are notable.

scholarly journals Extracranial Carotid and Vertebral Artery Dissection: A Review

2008 ◽  
Vol 35 (2) ◽  
pp. 146-152 ◽  
Author(s):  
Gary John Redekop
Keyword(s):  
Vertebral Artery ◽  
Cochrane Review ◽  
Vertebral Artery Dissection ◽  
Antiplatelet Agents ◽  
Carotid Artery Dissection ◽  
Annual Incidence ◽  
Artery Dissection ◽  
Blunt Injury ◽  
Injury Mechanisms

Dissection of the extracranial carotid and vertebral arteries is increasingly recognized as a cause of transient ischemic attacks and stroke. The annual incidence of spontaneous carotid artery dissection is 2.5 to 3 per 100,000, while the annual incidence of spontaneous vertebral artery dissection is 1 to 1.5 per 100,000. Traumatic dissection occurs in approximately 1% of all patients with blunt injury mechanisms, and is frequently initially unrecognized. Overall, dissections are estimated to account for only 2% of all ischemic strokes, but they are an important factor in the young, and account for approximately 20% of strokes in patients less than 45 years of age. Arterial dissection can cause ischemic stroke either by thromboemboli forming at the site of injury or as a result of hemodynamic insufficiency due to severe stenosis or occlusion. Available evidence strongly favors embolism as the most common cause. Both anticoagulation and antiplatelet agents have been advocated as treatment methods, but there is limited evidence on which to base these recommendations. A Cochrane review on the topic of antithrombotic drugs for carotid dissection did not identify any randomized trials, and did not find that anticoagulants were superior to antiplatelet agents for the primary outcomes of death and disability. Healing of arterial dissections occurs within three to six months, with resolution of stenosis seen in 90%, and recanalization of occlusions in as many as 50%. Dissecting aneurysms resolve on follow-up imaging in 5- 40%, decrease in size in 15-30%, and remain unchanged in 50-65%. Resolution is more common in vertebral dissections than in carotid dissections. Aneurysm enlargement occurs rarely. The uncommon patient presenting with acute hemodynamic insufficiency should be managed with measures to increase cerebral blood flow, and in this setting emergency stent placement to restore cerebral perfusion may be considered, provided that irreversible infarction has not already occurred.

Spontaneous Dissecting Pseudoaneurysm of the Extracranial Internal Carotid Artery: Endovascular Treatment with a Palmaz Stent

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 101-104 ◽  
Author(s):  
J. Deguchi ◽  
S. Nagasawa ◽  
H. Tanaka ◽  
S. Suzuki ◽  
Y. Hirota ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Conservative Therapy ◽  
Internal Carotid ◽  
Neurological Complications ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Spontaneous Dissection ◽  
Cervical Internal Carotid Artery

This case illustrates the usefulness of an endovascular stent to treat a pseudoaneurysm of the cervical internal carotid artery. A 46-year-old male patient presented with a spontaneous dissection of the cervical internal carotid artery. After failing conservative therapy, he was treated by endovascular placement of a Palmaz stent at level of the pseudoaneurysm and dissection. Immediate obliteration of pseudoaneurysm was achieved, and patency of the internal carotid artery was maintained. The patient sustained no neurological complications and the stenosis of treated carotid artery did not occur during the 6-month follow-up period. For internal carotid artery dissection, stent placement seems to be a reasonable therapeutic alternative to direct surgery.

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the G‐SCAD registry

2020 ◽  
Vol 16 ◽  
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
William T. Hurley ◽  
Abdulaziz Alasmari ◽  
Mohammed Ocheltree ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Cardiac Events ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Number Of Patients

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and linked to poor mental and physical health. Objective: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. Methods: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. Results: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. Conclusion: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Natural History of Cervical Artery Fibromuscular Dysplasia and Associated Neurovascular Events

2018 ◽  
Vol 46 (1-2) ◽  
pp. 33-39 ◽  
Author(s):  
Daniella Kadian-Dodov ◽  
Judith Z. Goldfinger ◽  
Susan Gustavson ◽  
Jeffrey W. Olin
Keyword(s):  
Fibromuscular Dysplasia ◽  
Medical Center ◽  
Imaging Study ◽  
Duplex Ultrasound ◽  
Complete Information ◽  
The United States ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Cervical Artery

Background and Purpose: Fibromuscular dysplasia (FMD) is a non-atherosclerotic arteriopathy most often affecting the carotid and renal arteries. In the United States Registry for FMD, 41.7% of patients experienced an aneurysm and/or dissection by the time of entry into the Registry. We sought to determine the occurrence of neurovascular events after FMD diagnosis and any changes on cervical artery imaging that may be attributable to FMD. Methods: Patients followed at the Mount Sinai Medical Center (US Registry for FMD enrollment center) with confirmed FMD and > 1 cervical artery imaging study (at least ± 6 months from the baseline carotid duplex ultrasound [CDU]) between the years 2003 and 2015 were included. Medical records and cervical artery imaging ([CDU], magnetic resonance angiogram [MRA], and computed tomography angiogram [CTA]) were reviewed. New arterial dissection, aneurysm, transient ischemic attack, stroke, or new FMD findings were recorded. Results: Among 146 FMD patients with complete information, 52 (35.6%) had an aneurysm and 52 (35.6%) had a dissection. Mean clinical follow-up was 35.3 ± 25.3 months (range 5–153 months); patients underwent 4 ± 2.7 CDU (range 1–17); 86.3% had ≥1 neck MRA or CTA. After FMD diagnosis, 3 patients (2%) experienced a new carotid artery dissection; 1 patient experienced a stroke due to concomitant atherosclerosis. No new aneurysms occurred. In patients with cervical artery FMD, imaging findings remained stable throughout follow-up. No patient developed new cervical artery FMD findings on follow-up imaging. Conclusions: No new cervical artery FMD or aneurysm was observed on subsequent imaging. New carotid dissection was uncommon over a mean follow-up period of 35.3 ± 25.3 months and was the only non-atherosclerotic vascular event observed after FMD diagnosis.

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