Endovascular treatment of acute intracranial vertebral artery dissection: long-term follow-up results of internal trapping and reconstructive treatment using coils and stents

2014 ◽  
Vol 7 (11) ◽  
pp. 829-834 ◽  
Author(s):  
Kyoung Hyup Nam ◽  
Jun Kyeung Ko ◽  
Seung Heon Cha ◽  
Chang Hwa Choi ◽  
Tae Hong Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Long Term Follow Up

scholarly journals Dissecting spontaneous vertebral artery aneurysms (V4). Endovascular Reconstructive techniques with fd stents. Case series

2020 ◽  
Vol 31 (4) ◽  
pp. 305-313
Author(s):  
João Victor Amaro de Souza ◽  
Guilherme Cabral de Andrade ◽  
Alexandre Lescszysnki ◽  
Helvercio F P Alves
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Case Series ◽  
Arterial Occlusion ◽  
Artery Dissection ◽  
Surgical Morbidity ◽  
Reconstructive Technique

Background: Spontaneous vertebral artery dissection (SVAD) is rare and occurs in young patients with subarachnoid hemorrhage (HSA) or stroke (3 to 5%). Only 11% occur in the V4 segment of VA. Its treatment changed in parallel with the progress of endovascular technology. Material and Methods: Six consecutive cases of dissecting vertebral artery aneurysms V4 are reported. All males with mean age 35 years. Clinical presentation with headache and neckache in all cases, ischemic stroke and SAH one case each. All patients underwent reconstructive endovascular treatment with FD stent, with or without microcoils. Results: All patients were under dual antiplatelet therapy before EVT (Aspirin 200mg and clopidogrel 75mg or ticagrelor 180mg/day). Reconstructive technique was performed with FD stent in two cases, associated of microcoils and “jailing technique” in two cases or multiple telescoping stents in three cases. Occlusion of the aneurysm and arterial permeability were found in long term follow up in 5 cases. In a case of fusiform aneurysm, there was late thrombosis of the telescoped stents and arterial occlusion without clinical repercussion. Conclusion: Due to the high rate of surgical morbidity, endovascular treatment became the first line for this kind of aneurysm. The reconstruction using a flow bypass and device reconstructive technique is an attractive alternative, showing long-term favorable clinical and angiographic outcomes with the ability to maintain patency of the parental and lateral branch arteries.

scholarly journals Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes

2019 ◽  
Vol 4 (4) ◽  
pp. 182-188
Author(s):  
Tanja Djurdjevic ◽  
André Cunha ◽  
Ursula Schulz ◽  
Dennis Briley ◽  
Peter Rothwell ◽  
...  
Keyword(s):  
High Risk ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Posterior Circulation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Recurrent Strokes

Background and purposeWe present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012. Data regarding presentation, follow-up, procedure details, complications and imaging follow-up were reviewed. All surviving patients underwent a phone interview to establish their current Modified Ranking Scales (MRS).ResultsStenoses of the intracranial vertebral artery (24 patients) and basilar artery (6 patients) were treated with stents (10 patients), angioplasty alone (13 patients) or both (5 patients). Two procedures failed. One patient (3.3%) died after the procedure, two had stroke (6.6%) and one a subarachnoid haemorrhage without ensuing deficit. Two patients (6.7%) had asymptomatic complications (dissection and pseudoaneurysm). The median clinical follow-up time was 7 years. Of the 29 patients who survived the procedure, 6 died due to unrelated causes. Three patients (10%) had recurrent strokes and two (6.7%) a transient ischaemic attack in the posterior circulation. Two patients had subsequent middle cerebral artery strokes. Five (16.7%) patients had recurrent stenoses and three (10%) occlusions of the treated artery. Retreatment was performed in six patients, three (10%) with PTA and three (10%) with stenting. Current MRS scores were as follows: nine MRS 0, eight MRS 1, four MRS 2 and one MRS 4.ConclusionsLong-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences. Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.

Stroke prevention by endovascular treatment of carotid and vertebral artery dissections

2016 ◽  
Vol 9 (10) ◽  
pp. 952-957 ◽  
Author(s):  
Karam Moon ◽  
Felipe C Albuquerque ◽  
Tyler Cole ◽  
Bradley A Gross ◽  
Cameron G McDougall
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Demographic Data ◽  
Vertebral Artery Dissection ◽  
Endovascular Intervention ◽  
Artery Dissection ◽  
Parent Artery ◽  
Indications For Treatment ◽  
Patient Reported

IntroductionEndovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances.ObjectiveTo review our institutional experience with endovascular treatment of cervical dissections over the past 20 years to examine indications for treatment, interventional methods, and outcomes.MethodsRetrospective review of a prospectively maintained database to identify patients with extracranial dissection who underwent endovascular intervention between January 1996 and January 2016. Demographic data and details of procedures, outcomes, and complications were extracted.ResultsOf 116 patients [93 CAD, 23 VAD; mean age 44.9 years (range 5–76 years)], 104 underwent stent placement; 11, coil occlusion of the parent artery; and 1, stenting with contralateral vessel occlusion. The cohorts were well matched for age, sex, dissection etiology, and admission and follow-up modified Rankin Scale (mRS) scores. Patients with CAD had significantly more stent placements (p<0.001), failure of medical therapy (p=0.004), and interventions for enlarging pseudoaneurysms (p=0.01) or thromboembolic events (p=0.004). Patients with VAD had significantly more interventions for traumatic occlusion with recanalization (p<0.001). Dissections were spontaneous (n=67), traumatic (n=36), or iatrogenic (n=13). Traumatic dissections in patients with CAD were associated with poor admission mRS scores (p=0.01). Six of 67 (9.0%) patients with spontaneous dissection reported recent chiropractic manipulation. Mean follow-up was 3.5 years (range 1–146 months). Permanent morbidity/mortality was 3.4%, including two deaths. Over a follow-up period of 364 patient-years, 1 stroke occurred (0.27% per year). At last follow-up, 41 previously disabled patients [CAD, 31/93 (33.3%); VAD, 10/23 (43.5%)] were no longer disabled; no patient reported worsened disability.ConclusionsPatients with CAD and VAD differ significantly in presentation, indications for treatment, and treatment methods. Endovascular treatment of CAD and VAD has low procedural morbidity and is associated with a low incidence of future stroke.

Extracranial and intracranial vertebral artery dissection: Long-term clinical and duplex sonographic follow-up

2008 ◽  
Vol 36 (8) ◽  
pp. 472-479 ◽  
Author(s):  
Tiemo Wessels ◽  
Maria Mosso ◽  
Timo Krings ◽  
Christof Klötzsch ◽  
Judith U. Harrer
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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