This Article Full Text Full Text (PDF) All Versions of this Article: 34/12/e254    most recent 01.STR.0000101915.11128.3Dv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohen, J. E. Articles by Ben-Hur, T. Search for Related Content PubMed PubMed Citation Articles by Cohen, J. E. Articles by Ben-Hur, T. Related Collections Carotid and Vertebral A. Dissection Emergency treatment of Stroke Angioplasty and Stenting

(Stroke. 2003;34:e254.)
© 2003 American Heart Association, Inc.

Case Report

Emergent Stenting to Treat Patients With Carotid Artery Dissection

Clinically and Radiologically Directed Therapeutic Decision Making

José E. Cohen, MD; Ronen R. Leker, MD; Marc Gotkine, MBBS; Moshe Gomori, MD Tamir Ben-Hur, MD, PhD

From the Departments of Neuroradiology (J.E.C., M. Gomori), Neurosurgery (J.E.C.), and Neurology (R.R.L., M. Gotkine, T.B.-H.) and the Agnes Ginges Center for Human Neurogenetics (R.R.L., M. Gotkine, T.B.-H.), Hadassah-Hebrew University Hospital, Jerusalem, Israel.

Correspondence to Tamir Ben-Hur, MD, PhD, Department of Neurology, Hadassah University Hospital, Ein Kerem, PO Box 12000, Jerusalem 91120, Israel. E-mail tamir{at}hadassah.org.il

Background and Purpose— Carotid artery dissection (CAD) is a common cause of stroke in young patients. Clots formed at the low-flow zone in the false arterial lumen may give rise to distal emboli, and the mural hematoma may eventually occlude the artery. Anticoagulation is currently the accepted treatment, but it is unknown which patients will improve spontaneously, which will respond to anticoagulation, and which will have an exacerbation of ischemic symptoms despite therapy. Endovascular treatment of CAD may be an attractive alternative to anticoagulation, and methods of identifying patients who stand to benefit from such therapy need to be established.

Methods— We present here 3 cases of spontaneous symptomatic CAD in which endovascular stenting procedures were performed on the basis of a paradigm aimed at identifying potentially salvageable but at-risk brain tissue by combining clinical with MRI (diffusion and perfusion) and angiographic data.

Results— Diffusion-perfusion MRI mismatches and/or evidence of cerebral ischemia on angiographic parenchymography were identified in all patients. They did not respond to anticoagulation, were therefore treated with endovascular stents, and had excellent outcomes.

Conclusions— Endovascular stent placement may be an immediate, effective, and safe method of restoring vessel lumen integrity. It may be considered for selected patients who are clinically symptomatic despite anticoagulant treatment and in whom neuroimaging methods suggest that the neurological signs originate from a viable, hypoperfused, ischemic penumbra.

Key Words: endovascular therapy • magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted • penumbra

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