This Article Full Text Full Text (PDF) All Versions of this Article: 38/8/2270    most recent STROKEAHA.106.481093v1 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 Lavallée, P. C. Articles by Amarenco, P. Search for Related Content PubMed PubMed Citation Articles by Lavallée, P. C. Articles by Amarenco, P. Related Collections Acute Cerebral Infarction Carotid and Vertebral A. Dissection Emergency treatment of Stroke Angioplasty and Stenting

(Stroke. 2007;38:2270.)
© 2007 American Heart Association, Inc.

Original Contributions

Stent-Assisted Endovascular Thrombolysis Versus Intravenous Thrombolysis in Internal Carotid Artery Dissection With Tandem Internal Carotid and Middle Cerebral Artery Occlusion

Philippa C. Lavallée, MD; Mickaël Mazighi, MD, PhD; Jean-Pierre Saint-Maurice, MD; Elena Meseguer, MD; Halim Abboud, MD; Isabelle F. Klein, MD, PhD; Emmanuel Houdart, MD Pierre Amarenco, MD

From the Department of Neurology and Stroke Centre (P.C.L., E.M., H.A., P.A.), Bichat University Hospital and Medical School; the Department of Neuroradiology (M.M., J.-P.S.-M., E.H.), Lariboisiere University Hospital and Medical School; and the Department of Radiology (I.F.K.), Bichat University Hospital and Medical School, Paris, France.

Correspondence to Pierre Amarenco, MD, Department of Neurology and Stroke Centre, Bichat University Hospital, Denis Diderot University and Medical School, 2 rue Henri Huchard, 75018 Paris, France. E-mail pierre{at}amarenco.net

Background and Purpose— Tandem internal carotid and middle cerebral artery occlusion independently predicts poor outcome after intravenous thrombolysis. Recanalization of internal carotid artery dissection by stent-assisted angioplasty has recently been proposed when anticoagulation fails to prevent a new ischemic event. We recently reported a case of tandem internal carotid and middle cerebral artery occlusion with dissection of the internal carotid artery successfully treated with endovascular stent-assisted thrombolysis.

Methods— We compared clinical outcomes in consecutive patients presenting with tandem internal carotid and middle cerebral artery occlusion with internal carotid artery dissection within 3 hours of symptom onset who were eligible for intravenous thrombolysis, treated by either endovascular stent-assisted thrombolysis or intravenous recombinant tissue-type plasminogen activator (rtPA) when an endovascular therapist was unavailable. National Institutes of Health Stroke Scale scores were obtained at baseline and after 24 hours. The modified Rankin Scale score was used to assess outcomes at 3 months. Arterial recanalization was assessed by magnetic resonance imaging.

Results— Of 10 patients screened, 6 were treated with endovascular therapy and 4 with intravenous rtPA. Before treatment, mean National Institutes of Health Stroke Scale scores were high and comparable in the 2 groups (17 and 16, respectively). In the endovascular group, all patients achieved middle cerebral artery recanalization with subsequent dramatic improvement versus only 1 patient with middle cerebral artery recanalization in the intravenous rtPA group. At 3 months, 4 patients in the endovascular group had a favorable outcome (modified Rankin Scale score=0). In the intravenous rtPA group, 3 patients had a poor outcome (modified Rankin Scale score3).

Conclusions— Endovascular stent-assisted thrombolysis is a promising treatment in tandem internal carotid and middle cerebral artery occlusion due to internal carotid artery dissection and compares favorably with intravenous rtPA.

Key Words: carotid artery • dissection • ischemic stroke • stent

This article has been cited by other articles:

				R. W. Baumgartner, D. Georgiadis, K. Nedeltchev, G. Schroth, H. Sarikaya, and M. Arnold Stent-Assisted Endovascular Thrombolysis Versus Intravenous Thrombolysis in Internal Carotid Artery Dissection With Tandem Internal Carotid and Middle Cerebral Artery Occlusion Stroke, February 1, 2008; 39(2): e27 - e28. [Full Text] [PDF]

				D. M. Pelz, E. I. Levy, and L. N. Hopkins Advances in Interventional Neuroradiology 2007 Stroke, February 1, 2008; 39(2): 268 - 272. [Full Text] [PDF]