BACKGROUND AND PURPOSE: Dissection of the carotid artery can, in certain ca
ses, lead to significant stenosis, occlusion, or pseudoaneurysm formation,
with subsequent hemodynamic and embolic infarcts, despite anticoagulant the
rapy, We sought to determine the therapeutic value of stent-supported angio
plasty retrospectively in this subset of patients who are poor candidates f
or medical therapy.
METHODS: Five men and five women (age range, 37-83 years; mean age, 51.2 ye
ars) with dissection of the internal (n=9) and common (n=1) carotid artery
were successfully treated with percutaneous endovascular balloon angioplast
y and stent placement, The etiology was spontaneous in five, iatrogenic in
three, and traumatic in two, Seven of the treated lesions were left-sided a
nd three were right-sided.
RESULTS: The treatment significantly improved dissection-related stenosis f
rom 74+/-5.5% to 5.5+/-2.8%, Two occlusive dissections were successfully re
canalized using microcatheter techniques during the acute phase. Multiple o
verlapping stents were needed in four patients to eliminate the inflow zone
and false lumen and establish an angiographically smooth outline within th
e true lumen. There was one case of retroperitoneal hemorrhage, but there w
ere no procedural transient ischemic attacks (TIAs), minor or major strokes
, or deaths (0%). Clinical outcome at latest follow-up (16.5+/-1.9 months)
showed significant improvements compared with pretreatment modified Rankin
score (0.7+/-0.3 vs 1.8+/-0.44) and Barthel index (99.5+/-0.5 vs 80.5+/-8.9
), One delayed stroke occurred in a treated patient with contralateral caro
tid occlusion following a hypotensive uterine hemorrhage at 8 months; the r
emaining nine patients have remained free of TIA or stroke.
CONCLUSION: In select cases of carotid dissection associated with critical
hemodynamic insufficiency or thromboembolic events that occur despite medic
al therapy, endovascular stent placement appears to be a safe and effective
method of restoring vessel lumen integrity, with good clinical outcome.