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    Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents

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    Authors
    Ansari, S. A.
    Kuhn, Anna L.
    Honarmand, A. R.
    Khan, M.
    Hurley, M. C.
    Potts, M. B.
    Jahromi, B. S.
    Shaibani, A.
    Gounis, Matthew J.
    Wakhloo, Ajay K.
    Puri, Ajit S.
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    UMass Chan Affiliations
    New England Center for Stroke Research
    Department of Radiology, Division of Neuroimaging and Intervention
    Document Type
    Journal Article
    Publication Date
    2017-01-11
    Keywords
    Cardiovascular Diseases
    Nervous System Diseases
    Radiology
    
    Metadata
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    Link to Full Text
    https://doi.org/10.3174/ajnr.A4965
    Abstract
    BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (>/=3 stents) and presenting with acute (<12>hours) ischemic stroke symptoms (NIHSS score, >/=4). We analyzed patient demographics, vascular risk factors, clinical presentations, imaging/angiographic findings, technical procedures/complications, and clinical outcomes. RESULTS: Fifteen patients (mean age, 51.5 years) with acute ischemic stroke (mean NIHSS score, 15) underwent endovascular stent reconstruction for vessel and/or ischemic tissue salvage. All carotid dissections presented with >70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b-3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of <20% in-stent stenosis. Early clinical improvement resulted in a mean discharge NIHSS score of 6, and 9/15 (60%) patients achieved a 90-day mRS of
    Source
    AJNR Am J Neuroradiol. 2017 Jan;38(1):97-104. doi: 10.3174/ajnr.A4965. Epub 2016 Nov 10. Link to article on publisher's site
    DOI
    10.3174/ajnr.A4965
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48104
    PubMed ID
    28059705
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.3174/ajnr.A4965
    Scopus Count
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    Radiology Publications

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