PT  - JOURNAL ARTICLE
AU  - P. Jeon
AU  - B.M. Kim
AU  - D.I. Kim
AU  - Y.S. Shin
AU  - K.H. Kim
AU  - S.I. Park
AU  - D.J. Kim
AU  - S.H. Suh
TI  - Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency
AID  - 10.3174/ajnr.A2115
DP  - 2010 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1529--1532
VI  - 31
IP  - 8
4099  - http://www.ajnr.org/content/31/8/1529.short
4100  - http://www.ajnr.org/content/31/8/1529.full
SO  - Am. J. Neuroradiol.2010 Sep 01; 31
AB  - BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency. MATERIALS AND METHODS: Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated. RESULTS: All patients presented with progressive (n = 6) or fluctuating (n = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion (n = 2) or critical stenosis (n = 6) in intracranial (n = 3) or extracranial (n = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis. CONCLUSIONS: Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD. ICAinternal carotid arteryICADICA dissectionmRSmodified Rankin ScaleNIHSSNational Institutes of Health Stroke Scale