P-022 Management of Long segment, Flow Limiting Internal Carotid Artery Dissections Presenting with Acute Ischaemic Stroke: A Case Series

2013 ◽  
Vol 5 (Suppl 2) ◽  
pp. A29.2-A30
Author(s):  
O Rahman ◽  
A Honmarand ◽  
M Soltanolkotabi ◽  
M Hurley ◽  
A Shaibani ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Internal Carotid ◽  
Case Series

scholarly journals Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke

2015 ◽  
Vol 21 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Ankit Mishra ◽  
Hannah Stockley ◽  
Tony Goddard ◽  
Hemant Sonwalker ◽  
Siddhartha Wuppalapati ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Cerebral Artery ◽  
Acute Ischaemic Stroke ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Extracranial Internal Carotid Artery ◽  
Mean Time

Objective Tandem occlusions involving both the extracranial internal carotid artery (ICA) and an intracranial artery typically respond poorly to intravenous (IV) tissue plasminogen activator (t-PA). We retrospectively review our experience with proximal ICA stenting and stent-assisted thrombectomy of the distal artery. Methods The data included patients that underwent carotid stenting and mechanical thrombectomy between 2012–2013. Radiographic, clinical, and procedural data were drawn from case notes, imaging records and discharge reports. Clinical outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs). Results Seven patients, with a mean age of 66.4 years and a mean admission NIHSS of 18.3, underwent this procedure and were included. Each presented with an occlusion of the proximal ICA, with additional occlusions of the ICA terminus ( n = 3), middle cerebral artery ( n = 5), or anterior cerebral artery ( n = 1). Recanalisation of all identified occlusions was achieved in all patients, with a Thrombolysis in Myocardial Infarction (TIMI) score of 3 and a Thrombolysis in Cerebral Infarction (TICI) score >2b achieved in each case. Mean time from onset of stroke symptoms to recanalisation was 287 min; mean time from first angiography to recanalisation was 52 min. Intracranial haemorrhages occurred in two patients, with no increase in NIHSS. There were no mortalities. Mean NIHSS at discharge was 4.9, and mRs at 90 days was one in all patients. Conclusions Treatment of tandem extracranial ICA and intracranial occlusions in the setting of acute ischaemic stroke with extracranial carotid artery stenting followed by adjunctive intracranial mechanical thrombectomy is both safe and effective, but further evaluation of this treatment modality is necessary.

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

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.

scholarly journals Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

2020 ◽  
Vol 33 (4) ◽  
pp. 297-305
Author(s):  
Mostafa Mahmoud ◽  
Ahmed Farag ◽  
Mostafa Farid ◽  
Ahmed Elserwi ◽  
Amr Abdelsamad ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Flow Diversion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

scholarly journals Intentional subintimal carotid stenting of internal carotid dissection in a patient with acute ischaemic stroke

2016 ◽  
Vol 23 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Nicola Limbucci ◽  
Sergio Nappini ◽  
Andrea Rosi ◽  
Leonardo Renieri ◽  
Arturo Consoli ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Clinical Recovery ◽  
Intracranial Embolism

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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