RT Journal Article
SR Electronic
T1 Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1529
OP 1532
DO 10.3174/ajnr.A2115
VO 31
IS 8
A1 P. Jeon
A1 B.M. Kim
A1 D.I. Kim
A1 Y.S. Shin
A1 K.H. Kim
A1 S.I. Park
A1 D.J. Kim
A1 S.H. Suh
YR 2010
UL http://www.ajnr.org/content/31/8/1529.abstract
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