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Carotid Dissection: Technical Factors Affecting Endovascular Therapy

Published online by Cambridge University Press:  02 December 2014

Felipe C. Albuquerque ,
Patrick P. Han ,
Robert F. Spetzler ,
Joseph M. Zabramski  and
Cameron G. McDougall
Felipe C. Albuquerque
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona USA
Patrick P. Han
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona USA
Robert F. Spetzler
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona USA
Joseph M. Zabramski
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona USA
Cameron G. McDougall
Affiliation:
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona USA
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Abstract

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Background and Purpose:

To delineate factors associated with the successful endovascular treatment of extracranial carotid dissections, the authors review their management of 13 cases.

Methods:

The records of 12 patients with 13 dissections were assessed with reference to mechanism of dissection, preoperative symptoms, presence of a pseudoaneurysm, treatment success, and etiology of treatment failure. Patients were followed prospectively and included six men and six women, ranging in age from 27 to 62 years.

Results:

Angioplasty and stenting were performed successfully in 11 of 13 procedures (10 of 12 patients). Follow-up in these 10 patients demonstrated excellent patency through the stented segment in nine of the 11 treated vessels. Two patients, both of whom suffered their original dissection as a result of endarterectomy, required further angioplasty and stenting for stenosis outside the previously treated arterial segment. Regarding the treatment failures, a stent deployment device could not navigate a tortuous loop in one, while a microwire could not be advanced beyond a pseudoaneurysm in the second. Six patients had pseudoaneurysms, four of which were treated only with stenting across the dissected arterial segment. All pseudoaneurysms treated in this fashion resolved. No permanent complications occurred as a result of endovascular therapy.

Conclusions:

Angioplasty and stenting can be performed safely to manage carotid dissection. A pseudoaneurysm or tortuous anatomy can preclude therapy although the former typically resolves if angioplasty and stenting are feasible. Dissections secondary to endarterectomy may be associated with a higher rate of restenosis after stenting and may require further treatment.

Résumé:

RÉSUMÉ:Introduction et Objectif:

Les auteurs revoient le traitement de 13 cas de dissection de la carotide extracrânienne afin d'identifier les facteurs associés au succès du traitement endovasculaire.

Méthodes:

Les dossiers de 12 patients présentant 13 dissections ont été révisés quant au mécanisme de la dissection, aux symptômes préopératoires, à la présence d'un pseudoanévrisme, au succès du traitement et à l'étiologie de l'échec du traitement. Les patients, six hommes et six femmes âgés de 27 à 62 ans, ont été suivis prospectivement.

Résultats:

L'angioplastie et la pose de prothèses endovasculaires ont été effectués avec succès lors de 11 des 13 interventions (10 patients sur 12). Le suivi de ces 10 patients a montré une excellente perméabilité au niveau de la prothèse endovasculaire chez neuf des 11 vaisseaux traités. Deux patients, qui avaient tous deux présenté une dissection suite à une endartérectomie, ont nécessité une nouvelle angioplastie et la mise en place d'une prothèse endovasculaire pour une sténose hors de la zone traitée antérieurement. En ce qui concerne les échecs, l'appareil de déploiement d'une prothèse endovasculaire n'a pas pu être guidé à travers une bouche d'une artère tortueuse dans un cas, alors qu'un microguide n'a pas pu être inséré au-delà d'un pseudoanévrisme dans le second. Six patients étaient porteurs de pseudoanévrismes, dont quatre ont été traités seulement par la mise en place d'une prothèse endovasculaire au niveau du segment artériel disséqué. Le traitement a été un succès dans tous ces cas et aucune complication permanente résultant du traitement endovasculaire n'est survenue.

Conclusions:

On peut traiter avec sécurité la dissection de la carotide par angioplastie et pose d'une prothèse endovasculaire. La présence d'un pseudoanévrisme ou d'une artère tortueuse peut entraver le traitement, bien qu'un pseudoanévrisme puisse se résorber avec l'angioplastie et la pose d'une prothèse endovasculaire lorsque c'est possible. Les dissections secondaires à une endartérectomie peuvent être associées à un taux de resténose plus élevé après la pose d'une prothèse endovasculaire et peuvent nécessiter une autre intervention.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 1 , February 2002 , pp. 54 - 60
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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