Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm

Yasha Kadkhodayan; David T Jeck; Christopher J Moran; Colin P Derdeyn; Dewitte T Cross III

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Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm

Journal article

Peer reviewed

Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm

Yasha Kadkhodayan, David T Jeck, Christopher J Moran, Colin P Derdeyn and Dewitte T Cross III

American journal of neuroradiology : AJNR, Vol.26(9), pp.2328-2335

10/2005

PMID: 16219841

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Abstract

Carotid angioplasty and stent placement may be the preferred treatment in patients with carotid dissection who have failed medical management. The goal of this study was to determine the procedural feasibility and safety as well as long-term complication rates of carotid angioplasty and stent placement in a consecutive cohort of relatively young, high-surgical-risk patients. A series of 26 consecutive patients (mean age, 49 years; 15 men and 11 women) who underwent angioplasty and stent placement for carotid dissection with or without pseudoaneurysm from April 1997 to April 2005 at our institution (9 traumatic, 8 spontaneous, and 9 iatrogenic) was retrospectively reviewed. Twenty-eight stents were used in 29 procedures performed on 27 vessels (20 internal carotid arteries and 7 common carotid arteries). Patients were followed with cerebral angiography, CT, sonography, or clinically for a mean of 14.6 months (range, 5 days to 48.2 months) with 17 of 26 patients having at least 6 months of follow-up. Procedural and long-term complication rates were calculated. Dissection-induced stenosis was reduced from 71 +/- 18% to no significant stenosis in 20 of the 21 patients with measurable stenosis. The procedural transient ischemic attack (TIA) rate was 3 of 29 procedures (10.3%). There were no procedural strokes. One patient required angioplasty of a common femoral artery. One procedure was terminated when an asymptomatic new intimal flap was created before intervention. Two patients had occlusions of the treated vessel noted at 22 days (presented with contralateral stroke) and 3.4 months (asymptomatic). There were 2 unrelated deaths from myocardial infarction at 8 days and 15.2 months. Two patients had recurrent ipsilateral TIA at 2.7 months and 12 months. The 30-day occlusion and death rate was 2 of 29 procedures (6.9%). In this series, angioplasty and stent placement were effective in relieving stenosis secondary to carotid dissection with or without pseudoaneurysm and have low rates of ischemic complications.

Radiography

Carotid Artery, Common - diagnostic imaging

Carotid Stenosis - etiology

Aneurysm, False - complications

Humans

Middle Aged

Carotid Stenosis - therapy

Male

Aneurysm, Dissecting - therapy

Angioplasty, Balloon - adverse effects

Carotid Artery, Internal, Dissection - diagnostic imaging

Carotid Artery, Internal, Dissection - therapy

Aneurysm, False - diagnostic imaging

Aneurysm, False - therapy

Aged, 80 and over

Adult

Aneurysm, Dissecting - diagnostic imaging

Female

Aged

Stents - adverse effects

Details

Title: Subtitle: Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm
Creators: Yasha Kadkhodayan - Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO 63310, USA
David T Jeck
Christopher J Moran
Colin P Derdeyn
Dewitte T Cross III
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.26(9), pp.2328-2335
Publisher: United States
PMID: 16219841
ISSN: 0195-6108
eISSN: 1936-959X
Language: English
Date published: 10/2005
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020745702771

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