Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections

  • Jiang, Yeqing (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Di, Ruoyu (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Lu, Gang (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Huang, Lei (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Wan, Hailin (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Ge, Liang (Department of Radiology, Huashan Hospital Affiliated to Fudan University) ;
  • Zhang, Xiaolong (Department of Radiology, Huashan Hospital Affiliated to Fudan University)
  • Received : 2021.07.30
  • Accepted : 2021.10.27
  • Published : 2022.05.01
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Abstract

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

Keywords

Acknowledgement

This study was supported by the National Nature Science Foundation of China (Grant No. 81771242).

References

  1. Ansari SA, Thompson BG, Gemmete JJ, Gandhi D : Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent. Neurosurgery 62 : 636-646; discussion 636-646, 2008 https://doi.org/10.1227/01.NEU.0000311350.25281.6B
  2. Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, et al. : Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 45 : 3155-3174, 2014 https://doi.org/10.1161/STR.0000000000000016
  3. Delgado F, Bravo I, Jimenez E, Murias E, Saiz A, Vega P, et al. : Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach. J Neurointerv Surg 9 : 11-16, 2017 https://doi.org/10.1136/neurintsurg-2016-012475
  4. Edgell RC, Abou-Chebl A, Yadav JS : Endovascular management of spontaneous carotid artery dissection. J Vasc Surg 42 : 854-860; discussion 860, 2005 https://doi.org/10.1016/j.jvs.2005.06.029
  5. Farouk M, Sato K, Matsumoto Y, Tominaga T : Endovascular treatment of internal carotid artery dissection presenting with acute ischemic stroke. J Stroke Cerebrovasc Dis 29 : 104592, 2020 https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104592
  6. Fava M, Meneses L, Loyola S, Tevah J, Bertoni H, Huete I, et al. : Carotid artery dissection: endovascular treatment. Report of 12 patients. Catheter Cardiovasc Interv 71 : 694-700, 2008 https://doi.org/10.1002/ccd.21483
  7. Koge J, Iwata T, Mizuta S, Nakamura Y, Matsumoto SI, Yamada T : Successful carotid artery stenting of a dissected, highly tortuous internal carotid artery after straightening with a peripheral microguidewire. J Clin Neurosci 53 : 265-268, 2018 https://doi.org/10.1016/j.jocn.2018.04.009
  8. Lee YJ, Ahn JY, Han IB, Chung YS, Hong CK, Joo JY : Therapeutic endovascular treatments for traumatic vertebral artery injuries. J Trauma 62 : 886-891, 2007 https://doi.org/10.1097/01.ta.0000209398.07973.60
  9. Leys D, Bandu L, Henon H, Lucas C, Mounier-Vehier F, Rondepierre P, et al. : Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 59 : 26-33, 2002 https://doi.org/10.1212/WNL.59.1.26
  10. Li MKA, Tsang ACO, Tsang FCP, Ho WS, Lee R, Leung GKK, et al. : Long-term risk of in-stent restenosis and stent fracture for extracranial vertebral artery stenting. Clin Neuroradiol 29 : 701-706, 2019 https://doi.org/10.1007/s00062-018-0708-y
  11. Mehta T, Patel S, Male S, Parikh R, Mehta K, Lakshminarayan K, et al. : Unplanned 30-day hospital readmissions of symptomatic carotid and vertebral artery dissection. J Stroke 20 : 407-410, 2018 https://doi.org/10.5853/jos.2018.02236
  12. Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, et al. : Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery 68 : 856-866; discussion 866, 2011 https://doi.org/10.1227/NEU.0b013e318209ce03
  13. Rahal JP, Gao B, Safain MG, Malek AM : Stent recanalization of carotid tonsillar loop dissection using the enterprise vascular reconstruction device. J Clin Neurosci 21 : 1141-1147, 2014 https://doi.org/10.1016/j.jocn.2013.11.007
  14. Robertson JJ, Koyfman A : Cervical artery dissections: a review. J Emerg Med 51 : 508-518, 2016 https://doi.org/10.1016/j.jemermed.2015.10.044
  15. Schievink WI : Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344 : 898-906, 2001 https://doi.org/10.1056/NEJM200103223441206
  16. Schulte S, Donas KP, Pitoulias GA, Horsch S : Endovascular treatment of iatrogenic and traumatic carotid artery dissection. Cardiovasc Intervent Radiol 31 : 870-874, 2008 https://doi.org/10.1007/s00270-008-9311-y
  17. Seifert T, Klein E, Legat-Wallner S, Krenn U, Brussee H, Lueger A, et al. : Bilateral vertebral artery dissection and infratentorial stroke complicated by stress-induced cardiomyopathy. J Neurol Neurosurg Psychiatry 79 : 480-481, 2008 https://doi.org/10.1136/jnnp.2007.133975
  18. Urasyanandana K, Songsang D, Aurboonyawat T, Chankaew E, Withayasuk P, Churojana A : Treatment outcomes in cerebral artery dissection and literature review. Interv Neuroradiol 24 : 254-262, 2018 https://doi.org/10.1177/1591019918755692
  19. Wang J, Yue D, Chen X, Wei Z, Lu W, Wu D : Common carotid artery dissection caused by radiotherapy: a case report. Mol Clin Oncol 5 : 475-477, 2016 https://doi.org/10.3892/mco.2016.990
  20. Zanaty M, Roa JA, Jabbour PM, Samaniego EA, Hasan DM : Recanalization of the chronically occluded internal carotid artery: review of the literature. World Neurosurg X 5 : 100067, 2020 https://doi.org/10.1016/j.wnsx.2019.100067