Primary Stenting of the Extracranial Internal Carotid Artery in a Patient with Multiple Cervical Dissections: Technical Case Report

Primary Stenting of the Extracranial Internal Carotid Artery in a Patient with Multiple Cervical... OBJECTIVE AND IMPORTANCE:Spontaneous dissection of the extracranial internal carotid artery (ICA) and vertebral artery (VA) is a welldocumented cause of stroke in young, previously healthy patients. The majority of patients with spontaneous dissection are successfully treated with antiplatelet or anticoagulation therapy, but a significant proportion of patients progress to suffer devastating morbidity and mortality. Surgical intervention has primarily consisted of proximal ligation, extracranialintracranial bypass, or endarterectomy. Generally, these procedures are technically demanding and yield disappointing clinical results.CLINICAL PRESENTATION/INTERVENTION:A 36-year-old man without a significant medical history initially presented with a several-day history of episodic right upper extremity weakness and numbness and visual obscurations. Cerebral angiography revealed bilateral ICA long segment narrowing (95%), distal left VA high-grade (95%) stenosis compatible with dissections, and right VA proximal occlusion. While therapeutically anticoagulated on heparin, the patient continued to experience crescendo episodes of right upper extremity paresis and paresthesias as well as aphasia. The patient underwent primary stenting of the left ICA, using a series of six overlapping stents (three Gianturco-Roubin coronary stents and three Palmaz-Schatz coronary stents). The patient remained symptom-free without neurological complications, and subsequent angiography performed at the 9-month follow-up examination confirmed continued patency of the stented left ICA as well as recanalization of the right ICA and VA.CONCLUSION:Neurovascular stents offer a minimally invasive and potentially efficacious treatment for the prevention of cerebral ischemia in patients with spontaneous extracranial dissection who remain symptomatic despite therapeutic anticoagulation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Primary Stenting of the Extracranial Internal Carotid Artery in a Patient with Multiple Cervical Dissections: Technical Case Report

Primary Stenting of the Extracranial Internal Carotid Artery in a Patient with Multiple Cervical Dissections: Technical Case Report

TECHNICAL CASE REPORTS S p o n t a n e o u s d i s s e c t i o n h a s b e e n shown Primary Stenting of the Extracranial to a c c o u n t f o r u p to 5 to 2 0 % o f ischemic s t r o k e s in p a t i e n t s u n d e r the a g e of 45 Internal Carotid Artery in a Patient with y e a r s ( 1 0 ) a n d 2 . 5 % o f p a t i e n t s with first s t r o k e s (2). T h e e x t r a c r a n i a l I C A is the Multiple Cervical Dissections: Technical m o s t f r e q u e n t s i t e o f s p o n t a n e o u s dis­ s e c t i o n , w i t h b o t h I C A s i n v o l v e d in a Case Report m i n o r i t y o f c a s e s ( < 1 5 % ) ( 1 3 ) . Between o n e - f o u r t h a n d o n e - h a l f o f patien ts with s p o n t a n e o u s d i s s e c t i o n o f the extracra­ n i a l I C A s u f f e r s t r o k e (3, 8, 1 5 , 28). In a Domagoj Coric, M.D., John A. W ilson, M.D., r e c e n t s e r i e s o f 80 c o n s e c u t i v e patients John D. Regan, M.D., D. Antonio Bell, M.D. w i t h c a r o t i d a r t e r y d i s s e c t i o n s , 42 pa­ Departments of Neurosurgery (D C , JAW) and Radiology (JDR), W ake Forest University Baptist t i e n t s ( 5 2 % ) s u f f e r e d n e u r o l o g i c a l defi­ Medical Center, W inston-Salem, and Department of Radiology (DAB), Presbyterian Hospital, c it s , w i t h s t r o k e o c c u r r i n g u p to 1 month Charlotte, North Carolina a f t e r r e c o g n i t i o n o f t h e d i s s e c t i o n (1). In a s t u d y o f 3 0 c o n s e c u t i v e p atien ts with s p o n t a n e o u s c a r o t i d d i s s e c t i o n who p r e s e n t e d w i t h a c u t e s t r o k e , 23% died O BJECTIV E A N D IM PO RTAN CE: Spontaneous dissection of the extracranial w i t h i n 1 w e e k a n d n e a r l y h a l f (48%) of internal carotid artery (ICA) and vertebral artery (VA) is a well- t h e l o n g - t e r m s u r v i v o r s s h o w e d severe documented cause of stroke in young, previously healthy patients. The n e u r o l o g i c a l i...
Loading next page...
 
/lp/ou_press/primary-stenting-of-the-extracranial-internal-carotid-artery-in-a-KfNH8SQZrl
Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199810000-00139
Publisher site
See Article on Publisher Site

Abstract

OBJECTIVE AND IMPORTANCE:Spontaneous dissection of the extracranial internal carotid artery (ICA) and vertebral artery (VA) is a welldocumented cause of stroke in young, previously healthy patients. The majority of patients with spontaneous dissection are successfully treated with antiplatelet or anticoagulation therapy, but a significant proportion of patients progress to suffer devastating morbidity and mortality. Surgical intervention has primarily consisted of proximal ligation, extracranialintracranial bypass, or endarterectomy. Generally, these procedures are technically demanding and yield disappointing clinical results.CLINICAL PRESENTATION/INTERVENTION:A 36-year-old man without a significant medical history initially presented with a several-day history of episodic right upper extremity weakness and numbness and visual obscurations. Cerebral angiography revealed bilateral ICA long segment narrowing (95%), distal left VA high-grade (95%) stenosis compatible with dissections, and right VA proximal occlusion. While therapeutically anticoagulated on heparin, the patient continued to experience crescendo episodes of right upper extremity paresis and paresthesias as well as aphasia. The patient underwent primary stenting of the left ICA, using a series of six overlapping stents (three Gianturco-Roubin coronary stents and three Palmaz-Schatz coronary stents). The patient remained symptom-free without neurological complications, and subsequent angiography performed at the 9-month follow-up examination confirmed continued patency of the stented left ICA as well as recanalization of the right ICA and VA.CONCLUSION:Neurovascular stents offer a minimally invasive and potentially efficacious treatment for the prevention of cerebral ischemia in patients with spontaneous extracranial dissection who remain symptomatic despite therapeutic anticoagulation.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1998

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off