Stroke prevention by endovascular treatment of carotid and vertebral artery dissections

Karam Moon, Felipe C. Albuquerque, Tyler Cole, Bradley A. Gross, Cameron McDougall

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Endovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances. Objective To review our institutional experience with endovascular treatment of cervical dissections over the past 20 years to examine indications for treatment, interventional methods, and outcomes. Methods Retrospective 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. Results Of 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 ( p0.001), 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 (p0.001). 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. Conclusions Patients 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.

Original languageEnglish (US)
Pages (from-to)952-957
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Stroke prevention by endovascular treatment of carotid and vertebral artery dissections'. Together they form a unique fingerprint.

Cite this