Long-term outcomes after carotid stent placement for treatment of carotid artery dissection

OBJECTIVE: To assess the long-term outcomes after stent placement for the t reatment of carotid artery dissections. METHODS: Between 1992 and 1998, seven patients underwent stenting procedure s for treatment of extracranial carotid artery dissections resulting from v arious causes, including trauma (n = 2), iatrogenesis (n = 2), spontaneous development (n = 2), and fibromuscular dysplasia (n = 1). Stenting procedur es were performed for large, nonhealing, dissection-induced pseudoaneurysms (four cases) or severe preocclusive stenosis (three cases). A total of 11 stents were placed (Palmaz stents, n = 8; Wallstents, n = 3). Radiological follow-up examinations were performed after a mean period of 17.7 months (r ange, 1-67 mo), using conventional or computed tomographic angiography. Cli nical follow-up data were obtained after a mean period of 42.9 months (rang e, 13-72 mo). RESULTS: All stent placements resulted in complete resolution of dissection -induced stenosis. For two of the four patients with aneurysms, the lesions occluded spontaneously at the time of the procedure. The third patient req uired coil embolization of the pseudoaneurysm. One patient exhibited progre ssive shrinkage of the aneurysm in serial follow-up examinations, with heal ing after 18 months. No clinical complications were associated with the pro cedures. One patient exhibited progression to asymptomatic occlusion 3 mont hs after stenting. The remaining six patients exhibited no significant chan ges in luminal diameters. All patients remained in clinically stable condit ion, with no ischemic symptoms, during more than 3.5 years (mean period) of follow-up monitoring. CONCLUSION: This experience suggests that stents placed for treatment of ex tracranial carotid artery dissections remain patent and patients remain fre e of symptoms on a long-term basis. Additional studies will be required to determine the optimal types of stents and intervals for follow-up monitorin g using imaging.