This Article Full Text Full Text (PDF) All Versions of this Article: 36/9/e80    most recent 01.STR.0000177883.50262.cfv1 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 Google Scholar Google Scholar Articles by Biondi, A. Articles by Gobin, Y. P. Search for Related Content PubMed PubMed Citation Articles by Biondi, A. Articles by Gobin, Y. P. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID Medline Plus Health Information Stroke Related Collections Angioplasty and Stenting Carotid and Vertebral A. Dissection Embolic stroke Angiography Primary and Secondary Stroke Prevention Stroke in Children and the Young

(Stroke. 2005;36:e80.)
© 2005 American Heart Association, Inc.

Case Reports

Progressive Symptomatic Carotid Dissection Treated With Multiple Stents

From the Departments of Radiology, Neurointerventional Unit (A.B., J.V., Y.P.G.) and Neurology (J.M.K., A.Z.S.), New York Presbyterian Hospital-Weill Medical College of Cornell University, New York.

Correspondence to Y. Pierre Gobin, MD, Radiology, Neurointerventional Unit, New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 E 68th St, Box 141, New York, NY 10021. E-mail yvg2001{at}med.cornell.edu

Abstract

Background and Purpose— Internal carotid artery (ICA) dissection remains a major cause of stroke in the young. Although systemic anticoagulation and antiplatelet therapy allow healing of the dissection in most patients, medical treatment can fail or be contraindicated. In selected cases of carotid dissections, the use of endovascular stent-assisted angioplasty has been reported to permit reconstruction of the extracranial ICA.

Methods— We report a case of symptomatic spontaneous carotid dissection which progressively extended from the cervical to the supraclinoid segments of the ICA in a 48-year-old patient under anticoagulant therapy. Because of failed medical therapy and further transient ischemic attacks (TIAs), the patient was treated by 5 tandem stents deployed in an overlapping fashion from the terminal ICA to the cervical segment.

Results— Postprocedure angiography demonstrated reconstitution of the luminal diameter of the ICA. The patient progressively improved and no further TIAs were observed. At 8-month follow-up, the vessel remained patent with a slight intra-extracranial reduction in size suggesting myointimal hyperplasia. Neurological exam was normal.

Conclusions— The successful angiographic and clinical results observed in our case of intra-extracranial stenting of a long dissection contributes to the literature of carotid dissection treated with multiple stents. The excellent mid-term follow-up in our patient confirms the efficacy of this treatment and good tolerance to multiple stents. To our knowledge this is the first case of spontaneous dissection treated with stenting including the distal supraclinoid segment, through an extensive proximally dissected artery.

Key Words: angioplasty • carotid artery, internal, dissection • carotid stenosis • ischemic attack, transient • stents