Long-term Outcomes after Carotid Stent Placement for Treatment of Carotid Artery Dissection

Long-term Outcomes after Carotid Stent Placement for Treatment of Carotid Artery Dissection AbstractOBJECTIVE:To assess the long-term outcomes after stent placement for the treatment of carotid artery dissections.METHODS:Between 1992 and 1998, seven patients underwent stenting procedures for treatment of extracranial carotid artery dissections resulting from various causes, including trauma (n = 2), iatrogenesis (n = 2), spontaneous development (n = 2), and fibromuscular dysplasia (n = 1). Stenting procedures were performed for large, nonhealing, dissection-induced pseudoaneurysms (four cases) or severe preocclusive stenosis (three cases). A total of 11 stents were placed (Palmaz stents, n = 8; Wallstents, n = 3). Radiological follow-up examinations were performed after a mean period of 17.7 months (range, 1-67 mo), using conventional or computed tomographic angiography. Clinical follow-up data were obtained after a mean period of 42.9 months (range, 13-72 mo).RESULTS:All stent placements resulted in complete resolution of dissection-induced stenosis. For two of the four patients with aneurysms, the lesions occluded spontaneously at the time of the procedure. The third patient required coil embolization of the pseudoaneurysm. One patient exhibited progressive shrinkage of the aneurysm in serial follow-up examinations, with healing after 18 months. No clinical complications were associated with the procedures. One patient exhibited progression to asymptomatic occlusion 3 months after stenting. The remaining six patients exhibited no significant changes in luminal diameters. All patients remained in clinically stable condition, with no ischemic symptoms, during more than 3.5 years (mean period) of follow-up monitoring.CONCLUSION:This experience suggests that stents placed for treatment of extracranial carotid artery dissections remain patent and patients remain free of symptoms on a long-term basis. Additional studies will be required to determine the optimal types of stents and intervals for follow-up monitoring using imaging. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Long-term Outcomes after Carotid Stent Placement for Treatment of Carotid Artery Dissection

Long-term Outcomes after Carotid Stent Placement for Treatment of Carotid Artery Dissection

L o n g - t e r m O u t c o m e s a f t e r C a r o t i d S t e n t P l a c e m e n t f o r T r e a t m e n t o f C a r o t i d A r t e r y D i s s e c t i o n A m o n Y . L i u , M . D . , R i c h a r d D . P a u l s e n , M . D . , M a r y L . M a r c e l l u s , R . N . , G a r y K . S t e i n b e r g , M . D . , P h . D . , M i c h a e l P . M a r k s , M . D . Departments of Radiology (AYL, RDP, M LM , M PM ) and Neurosurgery (GKS, M PM ), Stanford University School of Medicine, Stanford, California O B JE C T IV E : To assess the long-term outcomes after stent placem ent for the treatm ent of carotid artery dissections. M E T H O D S : Between 1992 and 1998, seven patients underwent stenting procedures for treatm ent of extracranial carotid artery dissections resulting from various causes, including traum a (n = 2), iatrogenesis (n = 2), spontaneous developm ent (n = 2), and fibrom uscular dysplasia (n = 1). Stenting procedures w ere performed for large, nonhealing, dissection-induced pseudoaneurysms (four cases) or severe preocclusive stenosis (three cases). A total of 11 stents w ere placed (Palm az stents, n = 8; W allstents, n = 3). Radiological follow-up examinations w ere performed after a mean period of 17.7 months (range, 1-67 mo), using conventional or computed tomographic angiography. C linical follow-up data w ere obtained after a mean period of 42.9 months (range, 13-72 mo). RESULTS: All stent placements resulted in com plete resolution of dissection-induced stenosis. For two of the four patients w ith aneurysms, the lesions occluded spontaneously at the time of the procedure. The third patient required coil embolization of the pseudoaneurysm. O n e patient exhibited progressive shrinkage of the aneurysm in serial follow-up examinations, w ith healing after 18 months. No clin ical com plications w ere associated with the procedures. O ne patient exhibited progression to asym ptom atic occlusion 3 months after stenting. The remaining six patients...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199912000-00022
Publisher site
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Abstract

AbstractOBJECTIVE:To assess the long-term outcomes after stent placement for the treatment of carotid artery dissections.METHODS:Between 1992 and 1998, seven patients underwent stenting procedures for treatment of extracranial carotid artery dissections resulting from various causes, including trauma (n = 2), iatrogenesis (n = 2), spontaneous development (n = 2), and fibromuscular dysplasia (n = 1). Stenting procedures were performed for large, nonhealing, dissection-induced pseudoaneurysms (four cases) or severe preocclusive stenosis (three cases). A total of 11 stents were placed (Palmaz stents, n = 8; Wallstents, n = 3). Radiological follow-up examinations were performed after a mean period of 17.7 months (range, 1-67 mo), using conventional or computed tomographic angiography. Clinical follow-up data were obtained after a mean period of 42.9 months (range, 13-72 mo).RESULTS:All stent placements resulted in complete resolution of dissection-induced stenosis. For two of the four patients with aneurysms, the lesions occluded spontaneously at the time of the procedure. The third patient required coil embolization of the pseudoaneurysm. One patient exhibited progressive shrinkage of the aneurysm in serial follow-up examinations, with healing after 18 months. No clinical complications were associated with the procedures. One patient exhibited progression to asymptomatic occlusion 3 months after stenting. The remaining six patients exhibited no significant changes in luminal diameters. All patients remained in clinically stable condition, with no ischemic symptoms, during more than 3.5 years (mean period) of follow-up monitoring.CONCLUSION:This experience suggests that stents placed for treatment of extracranial carotid artery dissections remain patent and patients remain free of symptoms on a long-term basis. Additional studies will be required to determine the optimal types of stents and intervals for follow-up monitoring using imaging.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1999

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