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Self-expanding stent placement for anterior circulation intracranial artery dissection presenting with ischemic symptoms

Authors
 Kim, Dong Joon  ;  Kim, Byung Moon  ;  Suh, Sang Hyun  ;  Kim, Dong Ik 
Citation
 Neurosurgery, Vol.76(2) : 158-164, 2015 
Journal Title
 Neurosurgery 
ISSN
 0148-396X 
Issue Date
2015
Abstract
BACKGROUND: The prognosis of ischemic anterior circulation intracranial dissection (AC-ICD) is poor and its optimal management is still controversial. OBJECTIVE: To evaluate the safety and efficacy of a self-expanding stent for ischemic AC-ICD. METHODS: Eight patients (mean age, 36 years) underwent self-expanding stenting for ischemic AC-ICD. Imaging findings of ischemic AC-ICD, the reason for stenting, and the clinical and angiographic outcomes were retrospectively evaluated. RESULTS: AC-ICD involved intracranial internal carotid artery to middle cerebral artery (MCA) in 2, intracranial internal carotid artery alone in 3, and MCA alone in 3 patients. Six AC-ICDs showed complete or near occlusions while 2 had a severe degree of stenosis. Six AC-ICDs showed an intimal flap and 3 had intramural hematomas. Six patients underwent emergent stenting for acute stroke within 6 hours (n=2) or crescendo-type stroke within 24 hours (n=4), while 2 patients had stenting for recurrent ischemia on dual antiplatelet and/or anticoagulation after the initial attack. The mean dissection-related stenosis improved from 93.1% to 20.3% after stenting (P<.05). The mean National Institutes of Health Stroke Scale score improved from 7.5 to 1.4 (P<.05). All patients had excellent or favorable outcomes at 3 months: modified Rankin Scale score, 0 in 3, 1 in 3, and 2 in 1 patient(s). No patients had subarachnoid hemorrhage or ischemic symptom recurrence during the clinical follow-up (mean, 27 months). All stented arteries were patent without significant in-stent stenosis on angiographic follow-up (range, 3-12 months). CONCLUSION: Self-expanding stents seem to be safe and effective for AC-ICD presenting with acute/crescendo-type stroke or recurrent ischemia despite adequate medication.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00006123-201502000-00016&LSLINK=80&D=ovft
DOI
10.1227/NEU.0000000000000582
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김동익(Kim, Dong Ik)
김동준(Kim, Dong Joon) ORCID logo https://orcid.org/0000-0002-7035-087X
김병문(Kim, Byung Moon) ORCID logo https://orcid.org/0000-0001-8593-6841
서상현(Suh, Sang Hyun) ORCID logo https://orcid.org/0000-0002-7098-4901
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139361
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