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Dejakum B, Kiechl S, Knoflach M, Mayer-Suess L. A narrative review on cervical artery dissection-related cranial nerve palsies. Front Neurol 2024; 15:1364218. [PMID: 38699055 PMCID: PMC11063253 DOI: 10.3389/fneur.2024.1364218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction This study aimed to emphasize the importance of cranial nerve (CN) palsies in spontaneous cervical artery dissection (sCeAD). Methods A search term-based literature review was conducted on "cervical artery dissection" and "cranial nerve palsy." English and German articles published until October 2023 were considered. Results Cranial nerve (CN) palsy in sCeAD is evident in approximately 10% of cases. In the literature, isolated palsies of CN II, III, VII, IX, X, and XII have been reported, while CN XI palsy only occurs in combination with other lower cranial nerve palsies. Dissection type and mural hematoma localization are specific to affected CN as CN palsies of II or III are solely evident in those with steno-occlusive vessel pathologies located at more proximal segments of ICA, while those with CN palsies of IX, X, XI, and XII occur in expansive sCeAD at more distal segments. This dichotomization emphasizes the hypothesis of a different pathomechanism in CN palsy associated with sCeAD, one being hypoperfusion or microembolism (CN II, III, and VII) and the other being a local mass effect on surrounding tissue (CN IX, X, XI, and XII). Clinically, the distinction between peripheral palsies and those caused by brainstem infarction is difficult. This differentiation is key, as, according to the reviewed cases, peripheral cranial nerve palsies in sCeAD patients mostly resolve completely over time, while those due to brainstem stroke do not, making cerebrovascular imaging appraisal essential. Discussion It is important to consider dissections as a potential cause of peripheral CN palsies and to be aware of the appropriate diagnostic pathways. This awareness can help clinicians make an early diagnosis, offering the opportunity for primary stroke prevention.
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Affiliation(s)
- Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage – Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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2
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Lu GD, Yang W, Jia ZY, Liu S. Endovascular reconstruction of high cervical and long-segment carotid artery dissections with Leo plus stent. Neuroradiology 2024; 66:409-416. [PMID: 38191867 DOI: 10.1007/s00234-023-03274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Endovascular reconstruction has emerged as a viable alternative for carotid artery dissections (CADs) that are unresponsive to antithrombotic therapy. However, high cervical and long-segment CADs pose challenges during endovascular treatment due to their distal location and tortuous anatomy. We presented our experiences using endovascular reconstruction with the Leo plus stent for this type of CAD. METHODS We conducted a retrospective review of patients with high cervical and long-segment CADs treated using the Leo plus stent. We analyzed patient demographics, clinical presentations, procedural features, complications, and follow-up outcomes. RESULTS A total of 17 patients (mean age, 48.1 years) with 17 CADs were identified. Seven of these dissections were accompanied by pseudoaneurysm. The mean length of the dissection was 5.7 cm, and the mean degree of stenosis was 92.3%. A single Leo plus stent was deployed in 15 patients, while another Wallstent carotid stent was used in 2 cases. All stents were successfully positioned in their intended sites. The average degree of residual stenosis was 22.2%. There were no perioperative complications. With a median follow-up duration of 29 months, no ischemic stroke events occurred. All but one Leo plus stent remained patent during follow-up, and all 7 pseudoaneurysms had disappeared at the last radiological assessment. CONCLUSION Our experience in treating high cervical and long-segment CADs with the Leo plus stent demonstrates that this approach is practical, safe, and effective, as evidenced by long-term observations. The Leo Plus stent appears to be a suitable option for managing this type of CAD.
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Affiliation(s)
- Guang-Dong Lu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Wei Yang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China.
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3
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Kara S, Gutierrez Munoz FG, Eckes J, Abdelmoneim SS, Nedd K. Posterior Inferior Cerebellar Artery Stroke Due to a Severe Right Vertebral Artery Stenosis With a Left Cervical Internal Carotid Artery Dissection: What's Next? Cureus 2024; 16:e55598. [PMID: 38586807 PMCID: PMC10994864 DOI: 10.7759/cureus.55598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Guidelines for the treatment and management of ischemic strokes triggered by stenosis versus dissection are well established. However, the presence of both entities in the same patient, although rare, poses challenges for short- and long-term treatment. Here, we describe the case of a 55-year-old man who presented to the emergency department with a 72-hour history of headache, dizziness, unbalanced gait, nausea, and two episodes of vomiting. Stroke was initially suspected, but the computerized tomography (CT) scan showed no hemorrhage. His magnetic resonance imaging (MRI) showed right inferior cerebellar acute ischemia in the territory of the right posterior inferior cerebellar artery (PICA), with smaller foci of early acute infarcts in the bilateral inferior cerebellum. Furthermore, magnetic resonance angiography (MRA) and CT angiography revealed right vertebral artery stenosis and left cervical internal carotid artery dissection (ICAD). This clinical report describes a rare case of stroke secondary to vertebral artery stenosis with concomitant carotid artery dissection. The treatment course and evolution are presented.
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Affiliation(s)
- Sam Kara
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | | | - Jeremy Eckes
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Sahar S Abdelmoneim
- Department of Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Kester Nedd
- Department of Neurology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Gupta C, Wagh V. Exploring the Multifaceted Causes of Ischemic Stroke: A Narrative Review. Cureus 2023; 15:e47531. [PMID: 38021859 PMCID: PMC10664821 DOI: 10.7759/cureus.47531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Neurologists are well-versed with acute ischemic stroke, a serious public health concern. Effective acute stroke treatment is built on the rapid application of reperfusion therapy. This calls for prompt symptom recognition by the general population as well as emergency workers, proper referral to specialized stroke centers, and thorough examination and assessment by the on-site stroke team. The main goal of treatment for certain individuals is to restore blood flow to the ischemic penumbra by using intravenous thrombolysis and/or endovascular thrombectomy. Acute stroke patients must be hospitalized and continuously monitored for early neurological decline in order to avoid subsequent problems. After swiftly determining the stroke mechanism, patients can start the proper secondary preventative actions.
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Affiliation(s)
- Chirag Gupta
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vasant Wagh
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Arcadi FA, Morabito R, Marino S, Formica C, Calabrò RS. Cervical Artery Dissection and Patent Foramen Ovale in Juvenile Stroke: Causality or Casuality? A Familiar Case Report. Med Sci (Basel) 2023; 11:medsci11020034. [PMID: 37218986 DOI: 10.3390/medsci11020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Cervical artery dissection (CAD) and Patent Foramen Ovale (PFO) are important causes of stroke in young patients. Although PFO is considered an independent risk factor for cerebral infarction in young adults with cryptogenic stroke, other concomitant causes may be necessary to cause brain injury. PFO could be a predisposing factor of stroke through several mechanisms including paradoxical embolism from a venous source, thrombus formation in atrial septum, or atrial arrhythmias causing cerebral thromboembolism. The pathophysiology of CAD is poorly understood and includes both constitutional and environmental factors. A causal association is often difficult to establish, as other predisposing factors may also play a role in CAD etiopathogenesis. We present a family with ischemic stroke (a father and his three daughters), in which the two different stroke causes are present. We hypothesized that a paradoxical embolism caused by PFO, associated with arterial wall disease, in the presence of a procoagulant state, could produce arterial dissection and then stroke.
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Affiliation(s)
| | - Rosa Morabito
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
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Das S, Ray BK, Mishra L, Chatterjee K, Mondal G, Paul DK. The Spectrum of Pediatric Infection-Associated Intracranial Arteriopathies and Acute Ischemic Stroke at 2 Eastern Indian Tertiary Care Centres. J Child Neurol 2023; 38:422-434. [PMID: 37138497 DOI: 10.1177/08830738231171800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Major and minor pediatric infections may cause intracranial arteriopathies, the long-term outcome of which we investigated and identified the factors influencing the progression/resolution of arteriopathies. METHODS We collected the clinical and radiological data of children aged 1 month-15 years who had ischemic stroke with definite arteriopathy following a recent febrile infection. Repeated neuroimaging was done over the next year to ascertain recurrent strokes and the progression and resolution of arteriopathies. RESULTS The anterior circulation was more frequently affected (83.33%), predominantly involving the middle cerebral artery (41.67%), resolving in 20.84% of cases and progressing in 33.33% of cases. Lesions were commonly unilateral (54.17%) and stenotic (75%), resulting predominantly in cortical infarcts (45.83%), with hemiparesis being the most common neurodeficiency. Apart from tubercular meningitis patients, others had a good functional outcome. CONCLUSION Lower age, minor infections, and unilateral arteriopathies had a significantly higher chance of resolution. Postviral arteriopathies had a significantly lower chance of progression compared with those following bacterial infections. Progressive and bilateral arteriopathies were significantly associated with worse outcomes and recurrent strokes.
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Affiliation(s)
- Suman Das
- Department of Neurology, North Bengal Medical College, Shusrutnagar, Darjeeling, West Bengal, India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurology, Kolkata, West Bengal, India
| | | | - Kaushani Chatterjee
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Gobinda Mondal
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Dilip Kumar Paul
- Dr. B C Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
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Scopelliti G, Karam A, Labreuche J, Bricout N, Marrama F, Diomedi M, Ben Hassen W, Leclerc X, Cordonnier C, Henon H, Casolla B. Internal carotid artery patency after mechanical thrombectomy for stroke due to occlusive dissection: Impact on outcome. Eur Stroke J 2022; 8:199-207. [PMID: 37021179 PMCID: PMC10069197 DOI: 10.1177/23969873221140649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Internal carotid artery dissection (ICAD) is a rare cause of acute ischemic stroke with large vessel occlusion (AIS-LVO). We aimed investigating the impact on outcome of internal carotid artery (ICA) patency after mechanical thrombectomy (MT) for AIS-LVO due to occlusive ICAD. Patients and methods: We included consecutive patients with AIS-LVO due to occlusive ICAD treated with MT from January 2015 to December 2020 in three European stroke centers. We excluded patients with unsuccessful intracranial reperfusion after MT (modified Thrombolysis in Cerebral Infarction (mTICI) score < 2b). We compared 3-month favorable clinical outcome rate, defined as a modified Rankin scale (mRS) score ⩽2, according to ICA status (patency vs occlusion) at the end of MT and at 24-h follow-up imaging, using univariate and multivariable models. Results: Among 70 included patients, ICA was patent in 54/70 (77%) at the end of MT, and in 36/66 (54.5%) patients with 24-h follow-up imaging. Among patients with ICA patency at the end of MT, 32% presented ICA occlusion at 24-h control imaging. Favorable 3-month outcome occurred in 41/54 (76%) patients with ICA patency post-MT and in 9/16 (56%) patients with occluded ICA post-MT ( p = 0.21). Rates of favorable outcome were significantly higher in patients with 24-h ICA patency compared to patients with 24-h ICA occlusion (32/36 [89%] vs 15/30 [50%]), with an adjusted odds ratio of 4.67 (95% CI: 1.26–17.25). Discussion and conclusion: Obtaining sustained (24-h) ICA patency after MT could be a therapeutic target for improving functional outcome in patients with AIS-LVO due to ICAD.
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Affiliation(s)
- Giuseppe Scopelliti
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Arnaud Karam
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | | | - Nicolas Bricout
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Federico Marrama
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Wagih Ben Hassen
- Department of Neuroradiology, GHU Paris, Université de Paris, INSERM UMR 1266, Paris, France
| | - Xavier Leclerc
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Barbara Casolla
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d’Azur University, Nice, France
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Shrestha S, Bao H, Gu H, Gao C, Zeng Y, Xie K, Shi Y, Zhao L, He B, Zhao W, Tang Z, Li Z. Association of dissection features and primary collateral circulation with ischemic stroke in patients with spontaneous internal carotid artery dissection: evaluated using vessel wall-MRI and MRA. Br J Radiol 2022; 95:20210845. [PMID: 35816551 PMCID: PMC10996963 DOI: 10.1259/bjr.20210845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/15/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the ischemic stroke risk factors in spontaneous internal carotid artery dissection (ICAD) patients via analyzing the dissection features and primary collateral circulation using vessel wall-MRI and magnetic resonance angiography. METHODS ICAD patients who had undergone VW-MRI were included in this study. A total of 36 patients were included and divided into ICAD stroke (N = 23) and non-stroke (N = 13) group. Dissection imaging features [intramural hematoma (IMH), length of IMH, intimal flap, double lumen, intraluminal thrombus, degree of stenosis] and primary collateral status were analyzed. The primary collateral score (0-4) was evaluated based on presence of anterior communicating and ipsilateral anterior cerebral artery A1 segment (0-2) and ipsilateral posterior communicating artery (0-2). RESULTS There were no significant differences in dissection imaging features such as presence of double lumen, intimal flap, IMH, length of IMH and intraluminal thrombus between the two groups. Degree of stenosis and primary collateral score showed significant differences between the two groups. CONCLUSION Both the poor primary collateral circulation and severe stenosis may play an important role in occurrence of ischemic stroke for spontaneous ICAD patients and good primary collateral circulation can help to reduce the incidence of infarction. ADVANCES IN KNOWLEDGE ICAD is one of the major causes of ischemic stroke. Early evaluation of the status of the Circle of Willis in ICAD patients by MRI may help to make treatment strategies and improve clinical outcome.
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Affiliation(s)
- Srijana Shrestha
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Han Bao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Heyi Gu
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Chao Gao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Yizhen Zeng
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Kaipeng Xie
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Yixin Shi
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Lei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Bo He
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Wei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Zhiwei Tang
- Department of Neurosurgery, First Affiliated Hospital of
Kunming Medical University,
Kunming, China
| | - Zongfang Li
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
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Guida A, Tortora F, Tortora M, Buono G, Marseglia M, Tarantino M, Rizzuti M, Loiudice G, Manganelli F, Briganti F. Dissective tandem stroke: an endovascular approach. Radiol Case Rep 2022; 17:2170-2174. [PMID: 35479967 PMCID: PMC9035657 DOI: 10.1016/j.radcr.2022.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.
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Affiliation(s)
- Amedeo Guida
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
- Corresponding author.
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giuseppe Buono
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Margherita Tarantino
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Michele Rizzuti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giovanni Loiudice
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive Sciences and Dentistry, University “Federico II”, Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
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González-Maestro V, Monteagudo-Vilavedra E, Rodríguez-Antuña J, Lendoiro-Fuentes M, Gómez MSB, Miño EM. Carotid artery dissection in Hutchinson-Gilford Progeria: a case report. BMC Pediatr 2022; 22:135. [PMID: 35287606 PMCID: PMC8922814 DOI: 10.1186/s12887-022-03179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Strokes in the paediatric age group have their own epidemiology and aetiology and are frequently misdiagnosed. As in the adult population, they present some risk factors that must be identified. Cerebral arteriopathies as a cause of paediatric ischaemic stroke present a very diverse aetiology and morphology. In this article we report a paediatric stroke in a patient who was diagnosed during his first months of life of Hutchinson-Gilford´s Progeria (HGP). This is a rare genetic condition caused by mutations in the LMNA gene, producing an aberrant lamin A protein. The disease leads to premature aging, and cardiovascular complications are the first cause of morbidity and mortality in these patients. Case presentation We report the case of a 5-year-old patient with HGP (missense mutation—de novo—c.1822G > A in heterozygosis, LMNA gene). The patient was diagnosed during his first year of life and presented distinct phenotypical features. No other relevant comorbidities were present. He was admitted to the emergency department for right hemiparesis with at least 4 h of evolution, with inability to open the hand and slight decrease in the level of consciousness (pedNIHSS 5–6). Cranial-CT and angio-CT showed findings indicative of left carotid dissection. Consensus was reached on conservative medical management with anticoagulation and antiplatelet therapy. In the first few days, the patient had a favourable evolution with resolution of the right lower limb hemiparesis and, one month after discharge, of the hand paresis. Conclusions The clinical manifestations, the vascular phenotype of the genetic mutation and the location of the radiological signs on a specific vascular morphology are indicative of carotid dissection. Spontaneous dissections occur under a predisposing risk factor or disease and are an exceptional finding in patients with HGP. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03179-4.
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Affiliation(s)
| | | | | | | | | | - Elena Maside Miño
- Paediatrics Department, Complexo Hospitalario Universitario de Ferrol, Sergas, Spain
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11
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Karam A, Bricout N, Khyeng M, Cordonnier C, Leclerc X, Henon H, Casolla B. Safety and outcome of mechanical thrombectomy in ischaemic stroke related to carotid artery dissection. J Neurol 2021. [PMID: 34184125 DOI: 10.1007/s00415-021-10656-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The net clinical benefit of mechanical thrombectomy (MT) in patients with anterior circulation ischaemic stroke associated with large vessel occlusion (AIS-LVO) related to carotid artery dissection (CAD) is uncertain. The aim of the study was to investigate the safety and clinical outcomes of patients treated by MT for a CAD-related stroke. METHODS We included consecutive patients with AIS-LVO treated by MT between 1st 2015 and January 1st 2020 at Lille University Hospital. We compared the safety and clinical outcomes, including successful recanalisation, defined as a modified thrombolysis in cerebral infarction (mTICI) ≥ 2b and favourable functional outcome at 3 months (defined as a modified Rankin Scale (mRS) ≤ 2 or equal to pre-stroke), in patients with CAD-related stroke versus patients with other aetiologies. RESULTS We included 1422 patients, among them, 43 patients with CAD-related AIS-LVO were matched to 86 patients with other aetiologies. Procedural complications, sICH (ECASS-3 criteria) and mortality rates were similar in the two groups (OR 0.85, 95% CI 0.21-3.49, p = 0.82; OR 1.54 95% CI 0.33-2.79, p = 0.58; OR 0.18 95% CI 0.02-1.46, p = 0.11, respectively), as well as the rates of intracranial angiographic successful recanalisation and favourable functional outcome (OR 0.67 (95% CI 0.26-1.73, p = 0.41; OR 1.26 (95% CI 0.61-2.64, p = 0.53). In patients with CAD-related stroke, intracranial angiographic success after MT was significantly associated with favourable functional outcome. CONCLUSIONS In patients with AIS-LVO related to CAD, safety profiles and clinical outcomes after MT are similar compared to matched patients with other stroke aetiologies.
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12
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Sugiyama K, Watanuki H, Futamura Y, Okada M, Oiwa T, Makino S, Matsuyama K. Impact of direct carotid artery perfusion in acute type A aortic dissection involving the common carotid artery. Gen Thorac Cardiovasc Surg 2021; 69:1467-1475. [PMID: 33797692 PMCID: PMC8017433 DOI: 10.1007/s11748-021-01628-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Objectives Acute type A aortic dissection complicated with brain ischemia is associated with significantly higher mortality risks. Even if rescued with central aortic repair, some patients develop permanent postoperative neurological deficiency postoperatively. We recently introduced direct common carotid artery perfusion for acute type A aortic dissection involving the common carotid artery. This study introduced this technique to prevent postoperative neurological deficiency by comparing brain protection strategies. Methods Among 91 acute type A aortic dissection patients treated at our hospital during August 2015–October 2020, the common carotid artery was involved in 19 (21%), which had > 90% stenosis in either of the carotid arteries on preoperative contrast-enhanced computed tomography. Twelve patients underwent conventional selective cerebral perfusion during August 2015–December 2018 and seven patients underwent direct carotid artery perfusion during January 2019–October 2020. We assessed patient characteristics, surgical courses, clinical outcomes, and neurological outcomes. Results The mean age was 69 (range 39–84) years; 17 patients were male (89%). Eight patients (42%) had neurological symptoms. Concomitant procedures, postoperative neurological symptoms, and late mortality were significantly associated with conventional selective cerebral perfusion. Five selective cerebral perfusion patients experienced worsened neurological symptoms and two died of broad cerebral ischemia. No direct carotid artery perfusion patient died during hospitalization or experienced worsened neurological outcomes. Conclusions Direct carotid artery perfusion may be useful in aortic dissection with brain ischemia because it does not aggravate neurological symptoms and is not associated with intraoperative cerebral infarction. However, it may be ineffective when cerebral infarction has already developed.
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Affiliation(s)
- Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Hirotaka Watanuki
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuhiro Futamura
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masaho Okada
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tatsunori Oiwa
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Satoshi Makino
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Katsuhiko Matsuyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Bratu IF, Ribigan AC, Stefan D, Davidoiu CR, Badea RS, Antochi FA. Internal Carotid Artery Dissection - A Case for Antithrombotic Therapy in the Era of (Minimally) Invasive Procedures. Maedica (Bucur) 2021; 15:536-542. [PMID: 33603914 DOI: 10.26574/maedica.2020.15.4.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives: Carotid artery dissection represents a common cause of stroke among people aged 30-45. We present two clinical cases and a review of the literature concerning the management of internal carotid artery dissections (ICADs). Materials and methods: The two patients are a 54-year-old male and a 40-year-old female. The first patient presented to our Neurology Department for one-week-old intense occipital headache. His clinical examination revealed left-sided miosis and upper eyelid ptosis. He underwent cerebral-cervical computed tomography (CT) and computed tomography angiography (CTA) scans and the latter revealed hemodynamically significant narrowing of both ICAs (right C1-C5 and left C1-C2 segments). Transcranial Doppler ultrasonography and Doppler ultrasonography (DUS) of the cervical-cerebral arteries showed right ICA occlusion at its origin (dissection fold and intraluminal thrombosis). Cervical magnetic resonance imaging (MRI) and time-of-flight magnetic resonance angiography (MRA) revealed a semilunar-shaped T2-weighted hypersignal present in the walls of the C1-C5 segments of the right ICA and of the C1-C2 segments of the left ICA, with bilaterally reduced intraluminal flow (right more than left). These findings indicated the presence of bilateral ICA intramural hematomas caused by subacute bilateral ICAD. The second patient presented to our Neurology Department for recurrent episodes of headache and lateral cervical pain on both sides. She underwent transcranial DUS and DUS of the cervicalcerebral arteries. They revealed right ICAD fold in its upper cervical segments. The CTA scan of the supra-aortic trunks showed hemodynamically significant narrowing with subsequent diminished blood flow in the upper cervical segments of right ICA. The patient was diagnosed with right ICAD. Results:Both patients were treated using antiplatelet therapy for primary prevention of ischaemic events. Follow-up at seven months and at six months, respectively, by means of CTA of the supra-aortic trunks or MRA of the cervical region, revealed the restoration of arterial patency with subsequent normal blood flow in both cases. Conclusions: The long-term outcomes of ICADs should be kept in mind when assigning medical or endovascular management on a case-by-case basis. Antiplatelet or anticoagulant therapy is a safe and effective first-line strategy in such patients, especially in cases that do not warrant particular management.
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Affiliation(s)
| | | | - Daniela Stefan
- Department of Neurology, Emergency University Hospital, Bucharest, Romania
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Lall A, Yavagal DR, Bornak A. Chronic total occlusion and spontaneous recanalization of the internal carotid artery: Natural history and management strategy. Vascular 2020; 29:733-741. [PMID: 33297876 DOI: 10.1177/1708538120978043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Spontaneous recanalization of a chronic total occlusion of the extra-cranial internal carotid artery is an under-reported clinical entity. This paper reviews the different etiologies of internal carotid artery occlusion, its natural course, as well as the significance and our recommendations for the management of spontaneous internal carotid artery recanalization. METHODS A review of literature on etiology, diagnosis, and treatment of internal carotid artery occlusion and recanalization was conducted. PubMed database was searched using the terms "internal carotid occlusion" and "recanalization". Articles were reviewed and studies involving the management of internal carotid artery occlusion and spontaneous recanalization were included. We subsequently developed a management algorithm for chronic total occlusion of the internal carotid artery and spontaneous recanalization of such lesions based on the available evidence. RESULTS Common etiologies of chronic total occlusion of the internal carotid artery include carotid atherosclerotic disease, cardioembolic, and carotid dissection. Progression of an asymptomatic to symptomatic occlusion is estimated at 2-8% annually. Well-compensated patients can be asymptomatic. In others, clinical symptoms range from ipsilateral or global hypoperfusion to embolic stroke in some cases of spontaneous recanalization. Spontaneous recanalization occurs in 2.3-10.3% of patients but rarely results in a cerebrovascular event. CONCLUSIONS Progression of an asymptomatic chronic total occlusion of the internal carotid artery to symptomatic is infrequent. The management algorithm of chronic total occlusion of the internal carotid artery and spontaneous recanalization of the internal carotid artery must be tailored to the patient based on symptoms, etiology of the lesion, imaging findings, surgical risk, and reliability for follow-up.
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Affiliation(s)
- Alex Lall
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
| | | | - Arash Bornak
- Vascular & Endovascular Surgery, University of Miami, Miami, FL, USA
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Pini R, Faggioli G, Fenelli C, Vacirca A, Gallitto E, Mascoli C, Abualhin M, Gargiulo M. Cervical artery dissection: presentation and treatment. Ital J Vasc Endovasc Surg 2020. [DOI: 10.23736/s1824-4777.20.01459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Farouk M, Sato K, Matsumoto Y, Tominaga T. Endovascular Treatment of Internal Carotid Artery Dissection Presenting with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104592. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/23/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023] Open
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Chen CJ, Green IE, Worrall BB, Southerland AM. Cerebral collaterals and stroke in patients with isolated carotid artery dissections. J Clin Neurosci 2020; 72:158-162. [DOI: 10.1016/j.jocn.2019.12.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
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Abstract
Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.
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Affiliation(s)
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA.
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20
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Serkin Z, Le S, Sila C. Treatment of Extracranial Arterial Dissection: the Roles of Antiplatelet Agents, Anticoagulants, and Stenting. Curr Treat Options Neurol 2019; 21:48. [DOI: 10.1007/s11940-019-0589-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Lin J, Liang Y, Lin J. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection-related ischemic stroke: a meta-analysis. J Neurol 2019; 267:1585-1593. [PMID: 31321515 DOI: 10.1007/s00415-019-09474-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of our meta-analysis is to evaluate the endovascular therapy (EVT) in patients with cervical artery dissection (CAD)-related acute ischemic stroke (AIS) by comparing its efficacy and safety with the ones of intravenous thrombolysis (IVT). METHODS A systematic search on EVT to CAD-related ischemic stroke is performed. The meta-analysis models are applied to calculate either the risk ratio (RR) with 95% confidence interval (CI) or pooled proportions with 95% CI of favorable functional outcome (mRS = 0-2), excellent functional outcome (mRS = 0-1), symptomatic intracranial hemorrhage (SICH), mortality and recurrent stroke between EVT and IVT in CAD-related stroke. The differences between the two treatment groups are analyzed by the pooled odds ratio value and Chi-squared test. RESULTS A total of 190 patients given EVT and 139 IVT-alone patients are included. By comparing EVT alone and IVT alone, patients treated with EVT alone are more likely to experience favorable outcomes than those treated with IVT alone (71.2% vs 53.4%). Besides, there is no significant difference in excellent functional outcome, SICH, mortality and recurrent stroke between the EVT-alone and IVT-alone groups (all P > 0.05). Towards general EVT (EVT with or without IVT), the outcomes are not significantly different from those of IVT alone except for a higher mortality rate (10.2% vs 3.2%). CONCLUSION Based on our findings, EVT is considered to be more efficacious than IVT for CAD-related AIS patients. Although EVT alone tends to be safe and promising, its safety needs to be further evaluated, particularly for EVT separating from IVT therapy.
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Affiliation(s)
- Jueying Lin
- Emergency Department, Zhongshan Hospital Xiamen University, No. 201, South Hubin Street, Siming District, Xiamen, 361000, Fujian, People's Republic of China.
| | - Yawei Liang
- Department of Statistics, University of South Carolina, Columbia, SC, USA
| | - Juexin Lin
- Department of Statistics, University of South Carolina, Columbia, SC, USA
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Pfaff JAR, Maurer C, Broussalis E, Janssen H, Blanc R, Dargazanli C, Costalat V, Piotin M, Runck F, Berlis A, Killer-Oberpfalzer M, Hensler JT, Bendszus M, Wodarg F, Möhlenbruch MA. Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions. J Neurointerv Surg 2019; 12:33-37. [PMID: 31308199 DOI: 10.1136/neurintsurg-2019-015032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent. METHODS Multicenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries. RESULTS Overall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9-18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent. CONCLUSION Acute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.
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Affiliation(s)
- Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Christoph Maurer
- Department of Diagnostic and Interventionell Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Erasmia Broussalis
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| | - Hendrik Janssen
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany.,Department of Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Frank Runck
- Department of Diagnostic and Interventionell Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventionell Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany
| | - Monika Killer-Oberpfalzer
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria
| | - Johannes Tobias Hensler
- Department of Radiology and Neuroradiology, UniversityHospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, UniversityHospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
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Malferrari G, Laterza D, Valzania F, Monaco D, Silingardi M, Pizzini AM. Rivaroxaban in cervical and “cervico-cerebral” artery dissections: a new therapeutic option? Neurol Sci 2019; 40:1591-6. [DOI: 10.1007/s10072-019-03882-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/02/2019] [Indexed: 12/30/2022]
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24
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Affiliation(s)
- Minho Han
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
- Department of Science for Aging, Yonsei University Graduate School, Seoul, Korea
| | - Junghye Choi
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
| | - Gang Sik Seo
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyo Suk Nam
- Department of Science for Aging, Yonsei University Graduate School, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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25
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Texakalidis P, Karasavvidis T, Giannopoulos S, Tzoumas A, Charisis N, Jabbour P, Machinis T, Rangel-Castilla L, Reavey-Cantwell J. Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review. Neurosurg Rev 2019; 43:931-940. [DOI: 10.1007/s10143-019-01092-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 12/18/2022]
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Borota L, Mahmoud E, Nyberg C. Neuroform Atlas stent in treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries: a single-centre experience. Interv Neuroradiol 2019; 25:390-396. [PMID: 30803334 DOI: 10.1177/1591019919830215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM OF THE STUDY To present our experience in the treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent. MATERIALS AND METHODS Between January 2017 and February 2018 we treated iatrogenic dissections of three internal carotid arteries and three vertebral arteries. These iatrogenic dissections occurred during the endovascular treatment of ruptured and unruptured intracranial aneurysms. The indication for stenting was haemodynamically significant, flow-limiting dissection with threatening flow arrest. In all six cases, the dissections were treated by placement of Neuroform Atlas stents in the dissected segments of internal carotid or vertebral arteries. Deployment of the stent was followed by the usual dual antiplatelet regimen. RESULTS Single or multiple Neuroform Atlas stents were deployed without any technical difficulties, and blood flow was restored immediately after placement of the stents in all six cases. Midterm follow-up (6-8 months) showed complete reconstruction of the shape and lumen of all treated arteries, with negligible intimal hyperplasia. CONCLUSION Our results indicate that a favourable outcome can be achieved by treating iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent.
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Affiliation(s)
- Ljubisa Borota
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - Ehab Mahmoud
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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Bricout N, Nouri N, Henon H, Estrade L, Boustia F, Leclerc X. Compliant balloon angioplasty for the treatment of internal carotid artery dissection. Interv Neuroradiol 2018; 25:47-50. [PMID: 30165775 DOI: 10.1177/1591019918796490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report describes the innovative management of a severe haemodynamic stroke related to an occlusive extracranial internal carotid artery dissection. Intravenous thrombolysis combined with endovascular treatment were undertaken on the basis of a total mismatch profile (National Institutes of Health stroke scale (NIHSS) score of 27 and infarct volume on diffusion-weighted imaging of 0 mL). Balloon angioplasty using a long and compliant balloon microcatheter allowed complete recovery of the intracranial blood flow. The patient showed dramatic clinical improvement (day 1, NIHSS 5) and favourable functional outcome (day 90, modified Rankin scale score 2). Day 90 follow-up brain magnetic resonance imaging revealed no ischaemic change and magnetic resonance angiography assessed the patency of the internal carotid artery.
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Affiliation(s)
- Nicolas Bricout
- 1 Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - Nasreddine Nouri
- 1 Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - Hilde Henon
- 2 Department of Vascular Neurology, Stroke Unit, University of Lille, CHU Lille, Lille, France
| | - Laurent Estrade
- 1 Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - Fakhreddine Boustia
- 1 Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
| | - Xavier Leclerc
- 1 Department of Interventional Neuroradiology, University of Lille, CHU Lille, Lille, France
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Marnat G, Bühlmann M, Eker OF, Gralla J, Machi P, Fischer U, Riquelme C, Arnold M, Bonafé A, Jung S, Costalat V, Mordasini P. Multicentric Experience in Distal-to-Proximal Revascularization of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection. AJNR Am J Neuroradiol 2018; 39:1093-1099. [PMID: 29700047 DOI: 10.3174/ajnr.a5640] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort. MATERIALS AND METHODS Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection. Atheromatous tandem occlusions were excluded. The first step in the revascularization procedure was intracranial thrombectomy. Then, cervical carotid stent placement was performed depending on the functionality of the circle of Willis and the persistence of residual cervical ICA occlusion, severe stenosis, or thrombus apposition. Efficiency, complications, and radiologic and clinical outcomes were recorded. RESULTS Thirty-four patients presenting with tandem occlusion stroke secondary to internal carotid dissection were treated during the study period. The mean age was 52.5 years, the mean initial NIHSS score was 17.29 ± 6.23, and the mean delay between onset and groin puncture was 3.58 ± 1.1 hours. Recanalization TICI 2b/3 was obtained in 21 cases (62%). Fifteen patients underwent cervical carotid stent placement. There was no recurrence of ipsilateral stroke in the nonstented subgroup. Twenty-one patients (67.65%) had a favorable clinical outcome after 3 months. CONCLUSIONS Endovascular treatment of internal carotid dissection-related tandem occlusion stroke using the distal-to-proximal recanalization strategy appears to be feasible, with low complication rates and considerable rates of successful recanalization.
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Affiliation(s)
- G Marnat
- From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France
| | - M Bühlmann
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - O F Eker
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - J Gralla
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - P Machi
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - U Fischer
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - C Riquelme
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - M Arnold
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - A Bonafé
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - S Jung
- University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.)
| | - V Costalat
- Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - P Mordasini
- From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France
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Janczak D, Ziomek A, Lesniak M, Malinowski M, Pormanczuk K, Janczak D, Dorobisz T, Chabowski M. The endovascular emergency treatment of an acute carotid artery dissection after Krav Maga training—a case report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917745232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Carotid artery dissection accounts for 20%–30% of all ischemic strokes in young patients aged <50 years. Recent guidelines on carotid disease management do not differentiate between traumatic and spontaneous dissection. We present a case of a 36-year-old male patient with the right internal carotid artery dissection treated with two XACT Abbot 6–8 mm × 40 mm stents placement after he was strangled during Krav Maga training. It is the most effective way to prevent the imminent stroke in the penumbral region. The safety and outcome of stent placement in internal carotid artery dissection remains unclear and further randomized trials are needed.
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Affiliation(s)
- Dariusz Janczak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Ziomek
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Michal Lesniak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Malinowski
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Kornel Pormanczuk
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Dawid Janczak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Tadeusz Dorobisz
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Eker OF, Panni P, Dargazanli C, Marnat G, Arquizan C, Machi P, Mourand I, Gascou G, Le Bars E, Costalat V, Bonafé A. Anterior Circulation Acute Ischemic Stroke Associated with Atherosclerotic Lesions of the Cervical ICA: A Nosologic Entity Apart. AJNR Am J Neuroradiol 2017; 38:2138-2145. [PMID: 29051203 DOI: 10.3174/ajnr.a5404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy for patients with acute ischemic stroke with tandem occlusions has been shown to present varying reperfusion successes and clinical outcomes. However, the heterogeneity of tandem occlusion etiology has been strongly neglected in previous studies. We retrospectively investigated patients with acute ischemic stroke atherothrombotic tandem occlusion. MATERIALS AND METHODS All consecutive patients with acute ischemic stroke with atherothrombotic tandem occlusions treated with mechanical thrombectomy in our center between September 2009 and April 2015 were analyzed. They were compared with patients with acute ischemic stroke with dissection-related tandem occlusion and isolated intracranial occlusion treated during the same period. Comparative univariate and multivariate analyses were conducted, including demographic data, safety, and rates of successful recanalization and good clinical outcome. RESULTS Despite comparable baseline severity of neurologic deficits and infarct core extension, patients with atherothrombotic tandem occlusions were older (P < .001), were more frequently smokers (P < .001), and had globally more cardiovascular risk factors (P < .001) than the other 2 groups of patients. The patients with atherothrombotic tandem occlusions had significantly longer procedural times (P < .001), lower recanalization rates (P = .004), and higher global burden of procedural complications (P < .001). In this group, procedural complications (OR = 0.15, P = .02) and the TICI 2b/3 reperfusion scores (OR = 17.76, P = .002) were independently predictive factors of favorable clinical outcome. CONCLUSIONS Our study suggests that atherothrombotic tandem occlusions represent a peculiar and different nosologic entity compared with dissection-related tandem occlusions. This challenging cause of acute ischemic stroke should be differentiated from other etiologies in patient management in future prospective studies.
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Affiliation(s)
- O F Eker
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - P Panni
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.).,Department of Neurosurgery and Radiosurgery (P.P.), San Raffaele University Hospital, Milan, Italy
| | - C Dargazanli
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - G Marnat
- Service de Neuroradiologie (G.M., I.M.), Hôpital Pellegrin, CHRU de Bordeaux, Bordeaux, France
| | - C Arquizan
- Service de Neurologie (C.A.), Hôpital Gui de Chauliac, CHRU de Montpellier, Montpellier, France
| | - P Machi
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - I Mourand
- Service de Neuroradiologie (G.M., I.M.), Hôpital Pellegrin, CHRU de Bordeaux, Bordeaux, France
| | - G Gascou
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - E Le Bars
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - V Costalat
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
| | - A Bonafé
- From the Service de Neuroradiologie (O.F.E., P.P., C.D., P.M., G.G., E.L.B., V.C., A.B.)
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Esianor BI, Haider AS, Engelhardt MI, Osumah T, Vayalumkal S, Thakur R, Leonard D, Haithcock J, Layton KF. Intracranial Ischemic Infarct Due to Blunt Force Trauma in a High School Football Player. Cureus 2017; 9:e1659. [PMID: 29147634 PMCID: PMC5675602 DOI: 10.7759/cureus.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ischemic stroke is an uncommon cause of death among teenagers and young adults; however, the etiologies differ when compared to ischemic strokes in older individuals. Large-vessel atherosclerosis and small-vessel disease causing ischemic stroke are rare for the teenage population, while cervicocerebral arterial dissections account for up to 20% of ischemic strokes. Here, we present the case of a 16-year-old male who developed internal carotid artery dissection (ICAD) after a head injury and subsequently developed ischemic stroke and seizures.
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Kim Y, Choi CH, Lee TH, Cho HJ, Sung SM, Baik SK, Ko JK. Endovascular Stenting for Symptomatic Carotid Dissection with Hemodynamic Insufficiency. World Neurosurg 2017; 102:598-607. [DOI: 10.1016/j.wneu.2017.03.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/21/2022]
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Affiliation(s)
- Thomas B Stoker
- Core Medical Trainee, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge
| | - Nicholas R Evans
- Clinical Research Fellow, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ
| | - Elizabeth A Warburton
- Consultant Stroke Physician, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge
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Moon K, Albuquerque FC, Cole T, Gross BA, McDougall CG. Stroke prevention by endovascular treatment of carotid and vertebral artery dissections. J Neurointerv Surg 2016; 9:952-957. [DOI: 10.1136/neurintsurg-2016-012565] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/04/2022]
Abstract
IntroductionEndovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances.ObjectiveTo review our institutional experience with endovascular treatment of cervical dissections over the past 20 years to examine indications for treatment, interventional methods, and outcomes.MethodsRetrospective review of a prospectively maintained database to identify patients with extracranial dissection who underwent endovascular intervention between January 1996 and January 2016. Demographic data and details of procedures, outcomes, and complications were extracted.ResultsOf 116 patients [93 CAD, 23 VAD; mean age 44.9 years (range 5–76 years)], 104 underwent stent placement; 11, coil occlusion of the parent artery; and 1, stenting with contralateral vessel occlusion. The cohorts were well matched for age, sex, dissection etiology, and admission and follow-up modified Rankin Scale (mRS) scores. Patients with CAD had significantly more stent placements (p<0.001), failure of medical therapy (p=0.004), and interventions for enlarging pseudoaneurysms (p=0.01) or thromboembolic events (p=0.004). Patients with VAD had significantly more interventions for traumatic occlusion with recanalization (p<0.001). Dissections were spontaneous (n=67), traumatic (n=36), or iatrogenic (n=13). Traumatic dissections in patients with CAD were associated with poor admission mRS scores (p=0.01). Six of 67 (9.0%) patients with spontaneous dissection reported recent chiropractic manipulation. Mean follow-up was 3.5 years (range 1–146 months). Permanent morbidity/mortality was 3.4%, including two deaths. Over a follow-up period of 364 patient-years, 1 stroke occurred (0.27% per year). At last follow-up, 41 previously disabled patients [CAD, 31/93 (33.3%); VAD, 10/23 (43.5%)] were no longer disabled; no patient reported worsened disability.ConclusionsPatients with CAD and VAD differ significantly in presentation, indications for treatment, and treatment methods. Endovascular treatment of CAD and VAD has low procedural morbidity and is associated with a low incidence of future stroke.
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Kervancioglu S, Sirikci A, Yigiter R, Cakir Y, Bayram MM. Endovascular Angioplasty-Stenting as a Definitive Treatment for Isolated Spontaneous Common Carotid Artery Dissection. Neuroradiol J 2016; 19:348-54. [DOI: 10.1177/197140090601900313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 05/11/2006] [Indexed: 11/17/2022] Open
Abstract
Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature.
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Affiliation(s)
- S. Kervancioglu
- Department of Radiology, University of Gaziantep, Faculty of Medicine; Gaziantep, Turkey
| | - A. Sirikci
- Department of Radiology, University of Gaziantep, Faculty of Medicine; Gaziantep, Turkey
| | - R. Yigiter
- Department of Neurology, University of Gaziantep, Faculty of Medicine; Gaziantep, Turkey
| | - Y. Cakir
- Department of Radiology, University of Gaziantep, Faculty of Medicine; Gaziantep, Turkey
| | - M. Metin Bayram
- Department of Radiology, University of Gaziantep, Faculty of Medicine; Gaziantep, Turkey
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Labropoulos N, Leon LR, Gonzalez-Fajardo JA, Mansour AM, Kang SS. Nonatherosclerotic Pathology of the Neck Vessels: Prevalence and Flow Patterns. Vasc Endovascular Surg 2016; 41:417-27. [DOI: 10.1177/1538574407303176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To determine the prevalence and flow characteristics of nonatherosclerotic pathologies of the cervical vessels. Design: From 1997 to 2003, 11 480 ultrasound tests were performed for neck vessel evaluation on patients with cerebrovascular symptoms and trauma, and on asymptomatic patients with a bruit, cervical mass, or prior to aortocoronary bypass. When necessary, these findings were confirmed by other imaging modalities. Results: A total of 3010 repeated tests were excluded, leaving 8470 patients. The prevalence of nonatherosclerotic pathologies (n = 55) was 0.65%. The most common was thromboembolism (n = 19, 0.22%), followed by dissection (n = 16, 0.19%), carotid body tumors (n = 5, 0.06%), aneurysms (n = 4, 0.05%), fibromuscular dysplasia (n = 4, 0.05%), Takayasu's arteritis (n = 1, 0.01%), pseudoaneurysms (n = 5, 0.06%), and arteriovenous fistulae (n = 1, 0.01%). Cerebrovascular symptoms were present in 27 patients (49%). Conclusion: Nonatherosclerotic pathology accounts for 0.65% of patients referred for neck vessel evaluation. About half of them are symptomatic. Diagnosis of these pathologies and knowledge of their flow characteristics is important for patient management.
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Affiliation(s)
- Nicos Labropoulos
- Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey,
| | - Luis R. Leon
- Vascular Surgery Section, Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona
| | | | - Ashraf M. Mansour
- Division of Vascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Steven S. Kang
- Division of Vascular Surgery, Loyola University Medical Center, Maywood, Illinois
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Ergül DF, Ekemen S, Özdemir Ö, Uzan Ç, Yelken B. Delayed Post-Traumatic Anisocoria. Turk J Anaesthesiol Reanim 2016; 43:209-11. [PMID: 27366498 DOI: 10.5152/tjar.2015.79847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/27/2014] [Indexed: 11/22/2022] Open
Abstract
Post-traumatic carotid artery dissection is one of the major causes of ischemic stroke in young patients; its diagnosis remains a challenge for clinicians because of its variable clinical presentation. An otherwise healthy 37-year-old man was referred to the intensive care unit of our faculty for the management of multiple trauma because of a car accident. At 11 days from admission, his doctor noticed the advent of anisocoria. A prompt treatment was instituted with anti-platelet and-coagulant agents. The patient had a complete resolution of symptoms. The prognosis was good, and the patient achieved a complete clinical recovery. He was discharged without any sequelae.
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Affiliation(s)
- Dursun Fırat Ergül
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Serdar Ekemen
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Özdemir
- Department of Neurology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Çağdaş Uzan
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Birgül Yelken
- Department of Anaesthesiology and Reanimation, Division of Intensive Care, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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See AP, Gross BA, Penn DL, Du R, Frerichs KU. Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm. J Cerebrovasc Endovasc Neurosurg 2016; 18:110-114. [PMID: 27790401 PMCID: PMC5081495 DOI: 10.7461/jcen.2016.18.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/29/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022] Open
Abstract
The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
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Affiliation(s)
- Alfred P See
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bradley A Gross
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - David L Penn
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
Background Clinical, pathological and radiological advances in recent years have considerably advanced our understanding of the incidence and underlying mechanisms producing dissection of the cervical arteries, which should have implications for medical and, surgical therapy in the near future. This review is a summary of progress to date. Summary of review Numerous published studies, primarily over the last decade, have generated a rapidly evolving data base especially in the areas of etiology, neuroimaging and more recently, arterial pathology and its genetic basis. Conclusion Dissection of the carotid and vertebral arteries, both intracranially and extracranially, is a major and frequently underdiagnosed cause of stroke, especially in the young. These advances in clinical epidemiological observations, and new radiological and pathological data, are gradually providing an evidence-based rationale for future trials of therapeutic interventions, using both drugs and devices.
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Affiliation(s)
- John W. Norris
- Division of Clinical Neuroscience, St Georges Hospital Medical School, University of London, SW17 0RE, UK
| | - Tobias Brandt
- Kliniken Schnieder/University of Heidelberg, Heidelberg, Germany
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Lin J, Sun Y, Zhao S, Xu J, Zhao C. Safety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of Observational Studies. Cerebrovasc Dis 2016; 42:272-9. [DOI: 10.1159/000446004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 04/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Although thrombolysis is considered to be the first-line treatment for ischemic stroke, there remains an ongoing controversy on the safety and efficacy of thrombolysis in cervical artery dissection (CAD). The aim of this meta-analysis was to assess observational data related to the safety and efficacy of thrombolysis in CAD-related ischemic stroke. Methods: We performed a systematic search of the efficacy of thrombolysis treatment in CAD-related ischemic stroke with appropriate observational studies identified for the study. The meta-analysis models in Comprehensive Meta-Analysis V2 software were applied to calculate the merged rates of favorable outcome (modified Rankin Scale, mRS 0-2), excellent outcome (mRS 0-1), intracranial hemorrhage (ICH), symptomatic ICH (SICH), mortality and recurrent stroke between thrombolysis and non-thrombolysis in CAD-related stroke. The difference of outcomes and adverse events between the 2 groups was compared by analyzing the pooled OR value and chi-square test using the software SPSS. Results: A total of 846 patients were identified from 10 studies (174 with thrombolysis; 672 with non-thrombolysis). The meta-analysis detected no significant statistical difference in the proportion of CAD-related stroke patients enjoying a favorable outcome at the 3 months' follow-up between the thrombolysis and non-thrombolysis groups (53.7 vs. 58.2%, OR 0.782, χ2 = 0.594, p > 0.05); non-thrombolysis was slightly superior than thrombolysis in terms of excellent outcome (52.4 vs. 34.4%, OR 0.489, χ2 = 9.143, p = 0.002). There was no significant difference in SICH, mortality and recurrent stroke rates between the 2 groups (all p > 0.05). ICH rate was higher in the thrombolysis group of CAD-related stroke patients compared to that in the non-thrombolysis group (12.3 vs. 7.4%, OR 2.647, χ2 = 4.127, p = 0.042). Conclusion: Thrombolysis seems to be equally safe and will achieve an efficacy similar to the efficacy of non-thrombolysis in patients with acute ischemic stroke due to CAD. It is also as effective as thrombolysis in stroke from miscellaneous causes. Therefore, CAD patients experiencing a stroke should not be denied thrombolysis therapy. However, this will need to be confirmed in large-scale randomized studies, especially involving intravenous thrombolysis treatment.
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Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, Ayrignac X, Bonafé A, Costalat V. Endovascular Management of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection Using a Distal to Proximal Approach: Insight from the RECOST Study. AJNR Am J Neuroradiol 2016; 37:1281-8. [PMID: 26965467 DOI: 10.3174/ajnr.a4752] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Internal carotid artery dissection is a common cause of stroke in young adults. It may be responsible for tandem occlusion defined by a cervical steno-occlusive carotid wall hematoma associated with an intracranial large-vessel stroke. Intravenous thrombolysis is associated with a poor clinical outcome in these cases, and endovascular treatment has not been specifically evaluated to date. Our aim was to evaluate endovascular treatment technical and clinical efficiency in this specific occlusion topography, in comparison with treatment of isolated anterior circulation stroke. MATERIALS AND METHODS As part of our ongoing prospective stroke data base started in August 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] Study), we analyzed all carotid artery dissection tandem occlusion strokes and isolated anterior circulation occlusions. All patients were selected for endovascular treatment according to clinical-radiologic mismatch, NIHSS ≥ 7 and DWI-ASPECTS ≥5, within 6 hours after onset. For carotid artery dissection, the revascularization procedure consisted first of distal recanalization by a stent retriever in the intracranial vessel. Following assessment of the circle of Willis, internal carotid artery stent placement was only performed in case of insufficiency. Carotid artery dissection treatment efficacy, safety, and clinical outcome were compared with the results of the isolated anterior circulation occlusion cohort. RESULTS Two hundred fifty-eight patients with an anterior circulation stroke were analyzed, including 57 with tandem occlusions (22%); among them, 20 were carotid artery dissection-related occlusions (7.6%). The median age of patients with tandem occlusions with internal carotid dissection was 52.45 versus 66.85 years for isolated anterior circulation occlusion (P < .05); the mean initial NIHSS score was 17.53 ± 4.11 versus 17.55 ± 4.8 (P = .983). The median DWI-ASPECTS was 6.05 versus 6.64 (P = .098), and the average time from onset to puncture was 4.38 for tandem occlusions versus 4.53 hours in isolated anterior circulation occlusion (P = .704). Complication rates and symptomatic intracranial hemorrhage were comparable in both groups (5% versus 3%, P = .49). The duration of the procedure was significantly prolonged in case of tandem occlusion (80.69 versus 65.45 minutes, P = .030). Fourteen patients with carotid artery dissection (70%) had a 3-month mRS of ≤ 2, without a significant difference from patients with an isolated anterior circulation occlusion (44%, P = .2). Only 5 carotid artery dissections (25%) necessitated cervical stent placement. No early ipsilateral stroke recurrence was recorded, despite the absence of stent placement in 15 patients (75%) with carotid artery dissection. CONCLUSIONS Mechanical endovascular treatment of carotid artery dissection tandem occlusions is safe and effective compared with isolated anterior circulation occlusion stroke therapy. Hence, a more conservative approach with stent placement only in cases of circle of Willis insufficiency may be a reliable and safe strategy.
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Affiliation(s)
- G Marnat
- From the Department of Interventional and Diagnostic Neuroradiology (G.M.), Bordeaux University Hospital, Bordeaux, France
| | - I Mourand
- Departments of Neurology (I.M., C.A., X.A.)
| | - O Eker
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - P Machi
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - C Arquizan
- Departments of Neurology (I.M., C.A., X.A.)
| | - C Riquelme
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - X Ayrignac
- Departments of Neurology (I.M., C.A., X.A.)
| | - A Bonafé
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
| | - V Costalat
- Interventional and Diagnostic Neuroradiology (O.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France
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Zhengxing X, Zhenwen C, Yuhao S, Zhihong Z, Liuguan B, Qingfang S. Management of traumatic carotid artery dissection: initial experience of a single center. Neurosurg Rev 2016; 39:393-9. [DOI: 10.1007/s10143-015-0689-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/05/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
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Pacheco FT, Alves CAPF, Gagliardi RJ, da Rocha AJ. Thrombus Features in Hyperacute Ischemic Stroke: A Perspective on Using Length and Density Evaluation. J Stroke Cerebrovasc Dis 2016; 25:144-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/09/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022] Open
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Ben Hassen W, Machet A, Edjlali-Goujon M, Legrand L, Ladoux A, Mellerio C, Bodiguel E, Gobin-Metteil MP, Trystram D, Rodriguez-Regent C, Mas JL, Plat M, Oppenheim C, Meder JF, Naggara O. Imaging of cervical artery dissection. Diagn Interv Imaging. 2014;95:1151-1161. [PMID: 25632417 DOI: 10.1016/j.diii.2014.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cervical artery dissection (CAD) may affect the internal carotid and/or the vertebral arteries. CAD is the leading cause of ischemic stroke in patients younger than 45 years. Specific treatment (aspirin or anticoagulants) can be implemented once the diagnosis of CAD has been confirmed. This diagnosis is based on detection of a mural haematoma on ultrasound or on MRI. The diagnosis can be suspected on contrast-enhanced MRA (magnetic resonance angiography) or CT angiography, in case of long stenosis, sparing the internal carotid bulb, or suspended, at the junction of V2 and V3 segments of the vertebral artery, in patients with no signs of atheroma of the cervical arteries. MRI is recommended as the first line imaging screening tool, including a fat suppressed T1 weighted sequence, acquired in the axial or oblique plane at 1.5T, or 3D at 3T. Complete resolution of the lumen abnormality occurred in 80% of cases, and CAD recurrence is rare, encountered in less than 5% of cases. Interventional neuroradiology (angioplasty and/or stenting of the dissected vessel) may be envisaged in rare cases of haemodynamic effects with recurring clinical infarctions in the short-term.
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Abstract
CONTEXT Cervical artery dissection (CAD) is a common cause of stroke in young adults. There is controversy over whether anticoagulation is superior to antiplatelet therapy in preventing stroke in patients with CAD, although meta-analyses to date have not shown any difference between the two treatments. EVIDENCE ACQUISITION We performed a PubMed search using each of the keywords: "Cervical artery dissection", "Dissection", "Carotid dissection", and "Vertebral dissection" between January 1st, 1990 and July 1st 2015. We identified evidence-based peer-reviewed articles, including randomized trials, case series and reports, and retrospective reviews that encompass the epidemiology, clinical manifestations, pathophysiology, treatment, and outcome of cervical artery dissection. RESULTS This paper highlights the mechanisms of cervical artery dissection and stroke in patients with dissection as well as the natural history and treatment. CONCLUSION Given the relatively rare incidence of this disease, multicenter studies with collaborative effort among stroke centers worldwide should be considered to enroll patients with cervical artery dissection in a randomized trial comparing the two treatments.
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Affiliation(s)
- Christina A Blum
- University of Pennsylvania Health System, Department of Neurology, Stroke division
| | - Shadi Yaghi
- Columbia University Medical Center, Department of Neurology, Stroke division
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Abstract
Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed. Diseases affecting the cavernous sinus and orbital apex region, such as cavernous sinus thrombosis or mucormycosis, can give rise to simultaneous vision loss and diplopia and, if not treated, may extend to the brain parenchyma causing permanent neurological sequela. An isolated third nerve palsy may be the harbinger of a cerebral aneurysm, carrying a significant risk of mortality. Horner syndrome can be the initial presentation of a carotid dissection, an important cause of stroke in the young adult. The neurohospitalist should be familiar with the workup and management of neuro-ophthalmological emergencies.
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Affiliation(s)
- João Lemos
- Michigan State University, East Lansing, MI, USA
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Kwon JY, Kim NY, Suh DC, Kang DW, Kwon SU, Kim JS. Intracranial and extracranial arterial dissection presenting with ischemic stroke: Lesion location and stroke mechanism. J Neurol Sci 2015; 358:371-6. [PMID: 26434614 DOI: 10.1016/j.jns.2015.09.368] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Background and purpose Although cervicocranial artery dissections (CADs) are common causes of ischemic stroke in young individuals, anatomical locations and mechanisms of ischemic strokes are still unclear. We evaluate the prevalence, location, and pathogenic mechanisms of ischemic stroke caused by CADs. METHODS We reviewed CAD patients who presented with acute (<7days) ischemic events and who had undergone diffusion weighted magnetic resonance imaging (MRI) and appropriate vascular imagings (MR angiography, computed tomography angiography, digital subtraction angiography, and high-resolution MRI). Stroke mechanisms were categorized as artery-to-artery (AA) embolism, local branch occlusion, in situ thrombotic occlusion and hemodynamic impairment. RESULTS One hundred and thirty-five patients with cerebral infarcts (n=125) or transient ischemic attacks (n=10) were included. The locations of 159 dissected vessels were: 77 vertebral, 29 internal carotid, 24 middle cerebral, 12 basilar, eight posterior inferior cerebellar, five anterior cerebral, and four posterior cerebral arteries. Among stroke mechanisms, A-A embolism (n=70, 55.5%) was the most common followed by local branch occlusions (n=40, 31.7%) and in situ thrombotic occlusions (n=8, 6.3%). Intracranial CADs were more common (89 vs. 44), less often associated with trauma (21.3% vs. 40.9%, p=0.018) and A-A embolism (32.9% vs. 97.6%, p<0.001), and more often treated with intravenous thrombolysis (15.7% vs. 2.3%. p=0.021) than extracranial CADs. CONCLUSIONS In our cohort, intracranial CADs are more common than extracranial CADs, and the vertebral artery is the most frequently involved site. Although A-A embolism is the main stroke mechanism, local branch occlusion is another important stroke mechanism.
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Affiliation(s)
- Joo Young Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Na-Young Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Dae C Suh
- Department of Neuroradiology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
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Abstract
Acute carotid occlusion or near-occlusion with concomitant intracranial embolism cause severe acute ischemic strokes in patients. These concomitant occlusions have suggested poor response to intravenous thrombolysis and complicate endovascular treatment. Nevertheless, endovascular stent-assisted thrombectomy may improve outcome in patients but the treatment is not without concerns. Required antiplatelet therapy to prevent stent thrombosis may increase the rate of intracranial hemorrhage, especially after recent thrombolysis. Furthermore, technical difficulties in access of the intracranial vasculature may cause adverse events, even in the hands of experienced interventionalists. These concerns currently defy the treatment in being recommended for general use and only on a compassionate basis. However, recent patient series have suggested reasonable safety and efficacy for carotid stent-assisted thrombectomy.
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Affiliation(s)
| | - Derk W Krieger
- Department of Neurology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.,Faculty of Health & Medical Science, University of Copenhagen, Blegdamsvej 3B, København N 2200, Denmark
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Mustanoja S, Metso TM, Putaala J, Heikkinen N, Haapaniemi E, Salonen O, Tatlisumak T. Helsinki experience on nonvitamin K oral anticoagulants for treating cervical artery dissection. Brain Behav 2015; 5:e00349. [PMID: 26356074 PMCID: PMC4559015 DOI: 10.1002/brb3.349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/23/2015] [Accepted: 04/05/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cervical artery dissection (CeAD) patients with or without stroke are frequently treated with either antiplatelet agents or vitamin K antagonists (VKAs), but few data are reported on the use of nonvitamin K oral anticoagulants (NOACs). METHODS Between November 2011 and January 2014, we recorded data from patients with a stroke due to vertebral (VAD) or internal carotid artery dissection (ICAD). Patients using oral anticoagulants were included in the study and were divided into two treatment groups: patients using NOACs and those using VKAs. Excellent outcome was defined on modified Rankin Scale (mRS) ≤1 at 6 months. RESULTS Of 68 stroke patients (67% male; median age 45 [39-53]), six (8.8%; two with VAD and four with ICAD) were treated with NOACs: three with direct thrombin inhibitor dabigatran and three with direct factor Xa inhibitor rivaroxaban. National Institutes of Health Stroke Scale score at baseline was 4 (3-7) in the NOAC versus 2 (1-7) in the VKA groups. Complete recanalization at 6 months was seen in most patients in the NOAC (n = 5; 83%) and VKA (n = 34; 55%) groups. All the patients using NOACs had mRS ≤1 at 6 months and none had an intracerebral hemorrhage (ICH). In the VKA group most patients (n = 48; 77%) had mRS ≤1, one patient (1.7%) had an ICH and one died. CONCLUSIONS In this small, consecutive single-center patient sample treating ischemic stroke patients with CeAD with NOACs did not bring up safety concerns and resulted in similar, good outcomes compared to patients using VKAs.
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Affiliation(s)
- Satu Mustanoja
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Tiina M Metso
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Noora Heikkinen
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Elena Haapaniemi
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
| | - Oili Salonen
- Department of Neuroradiology, Helsinki University Central Hospital Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital Helsinki, Finland
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Li Q, Wang J, Chen H, Gong X, Ma N, Gao K, He L, Guan M, Chen Z, Li R, Mi D, Yuan C, Zhao X, Zhao XH. Characterization of Craniocervical Artery Dissection by Simultaneous MR Noncontrast Angiography and Intraplaque Hemorrhage Imaging at 3T. AJNR Am J Neuroradiol 2015; 36:1769-75. [PMID: 26045573 DOI: 10.3174/ajnr.a4348] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Craniocervical artery dissection is the most common cause of ischemic stroke identified in young adults. For the diagnosis of craniocervical artery dissection, multisequence MR imaging is recommended but is time-consuming. Recently, investigators proposed a simultaneous noncontrast angiography and intraplaque hemorrhage imaging technique allowing simultaneous noncontrast MRA and vessel wall imaging in a single scan. This study sought to investigate the feasibility of 3D simultaneous noncontrast angiography and intraplaque hemorrhage MR imaging in the characterization of craniocervical artery dissection. MATERIALS AND METHODS Twenty-four symptomatic patients (mean age, 45.0 ± 16.1 years; 21 men) with suspected craniocervical artery dissection were recruited. The 3D simultaneous noncontrast angiography and intraplaque hemorrhage 3D TOF MRA and black-blood imaging sequences were performed on a 3T MR imaging scanner. The agreement between simultaneous noncontrast angiography and intraplaque hemorrhage imaging and multisequence MR imaging in evaluating arterial dissection was determined. RESULTS Dissection was found to involve 1 artery in 22 patients and 2 arteries in 2 patients. The intramural hematoma and luminal occlusion were detected in 19 (79.2%) and 11 (45.8%) patients, respectively. In measuring stenosis, the Cohen κ value between 3D TOF MRA and simultaneous noncontrast angiography and intraplaque hemorrhage imaging was 0.82 (P < .001). All intramural hematomas on multisequence imaging were successfully identified by simultaneous noncontrast angiography and intraplaque hemorrhage imaging. CONCLUSIONS 3D simultaneous noncontrast angiography and intraplaque hemorrhage imaging showed excellent agreement with multisequence MR imaging in evaluating luminal stenosis and intramural hematoma in patients with craniocervical artery dissection. The simultaneous noncontrast angiography and intraplaque hemorrhage imaging saved nearly 50% of scanning time compared with multisequence MR imaging. Our findings suggest that 3D simultaneous noncontrast angiography and intraplaque hemorrhage imaging might be an alternative, time-efficient diagnostic tool for craniocervical artery dissection.
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Affiliation(s)
- Q Li
- From the Departments of Neurology (Q.L., X.G., D.M., X.Z.) Department of Neurology (Q.L.), People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - J Wang
- Clinical Sites Research Program (J.W.), Philips Research North America, Briarcliff Manor, New York
| | - H Chen
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - X Gong
- From the Departments of Neurology (Q.L., X.G., D.M., X.Z.)
| | - N Ma
- Interventional Neuroradiology (N.M., K.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - K Gao
- Interventional Neuroradiology (N.M., K.G.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - L He
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - M Guan
- Department of Radiology (M.G.), Yangzhou First People's Hospital, Yangzhou, China
| | - Z Chen
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - R Li
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
| | - D Mi
- From the Departments of Neurology (Q.L., X.G., D.M., X.Z.)
| | - C Yuan
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China Department of Radiology (C.Y.), University of Washington, Seattle, Washington
| | - X Zhao
- From the Departments of Neurology (Q.L., X.G., D.M., X.Z.)
| | - X H Zhao
- Department of Biomedical Engineering (H.C., L.H., Z.C., R.L., C.Y., X.H.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China
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