Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome.

Abstract

INTRODUCTION:

In 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.

METHODS:

From 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.

RESULTS:

In 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 %.

CONCLUSION:

EVT 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.

• Authors: Wiebke Kurre, Kai Bansemir, Marta Aguilar Pérez, Rosa Martinez Moreno, Elisabeth Schmid, Hansjörg Bäzner, Hans Henkes
• Journal: Neuroradiology (Neuroradiology) Vol. 58 Issue 12 Pg. 1167-1179 (Dec 2016) ISSN: 1432-1920 [Electronic] Germany
• PMID: 27796447 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Carotid Artery, Internal, Dissection (diagnostic imaging, mortality, therapy)
• Causality
• Computed Tomography Angiography (methods, statistics & numerical data)
• Endovascular Procedures (mortality, statistics & numerical data)
• Female
• Germany (epidemiology)
• Humans
• Male
• Middle Aged
• Postoperative Complications (mortality, prevention & control)
• Prevalence
• Retrospective Studies
• Risk Factors
• Survival Rate
• Thromboembolism (mortality, prevention & control)
• Treatment Outcome