Document Detail

Emergent stenting to treat patients with carotid artery dissection: clinically and radiologically directed therapeutic decision making.
MedLine Citation:
PMID:  14605318     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Carotid artery dissection (CAD) is a common cause of stroke in young patients. Clots formed at the low-flow zone in the false arterial lumen may give rise to distal emboli, and the mural hematoma may eventually occlude the artery. Anticoagulation is currently the accepted treatment, but it is unknown which patients will improve spontaneously, which will respond to anticoagulation, and which will have an exacerbation of ischemic symptoms despite therapy. Endovascular treatment of CAD may be an attractive alternative to anticoagulation, and methods of identifying patients who stand to benefit from such therapy need to be established. METHODS: We present here 3 cases of spontaneous symptomatic CAD in which endovascular stenting procedures were performed on the basis of a paradigm aimed at identifying potentially salvageable but at-risk brain tissue by combining clinical with MRI (diffusion and perfusion) and angiographic data. RESULTS: Diffusion-perfusion MRI mismatches and/or evidence of cerebral ischemia on angiographic parenchymography were identified in all patients. They did not respond to anticoagulation, were therefore treated with endovascular stents, and had excellent outcomes. CONCLUSIONS: Endovascular stent placement may be an immediate, effective, and safe method of restoring vessel lumen integrity. It may be considered for selected patients who are clinically symptomatic despite anticoagulant treatment and in whom neuroimaging methods suggest that the neurological signs originate from a viable, hypoperfused, ischemic penumbra.
José E Cohen; Ronen R Leker; Marc Gotkine; Moshe Gomori; Tamir Ben-Hur
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2003-11-06
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  34     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-05     Completed Date:  2004-01-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e254-7     Citation Subset:  IM    
Department of Neuroradiology, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
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MeSH Terms
Blood Vessel Prosthesis Implantation
Carotid Artery, Internal / radiography,  surgery,  ultrasonography
Carotid Artery, Internal, Dissection / complications,  diagnosis*,  surgery*
Cerebral Infarction / diagnosis,  etiology
Magnetic Resonance Imaging
Middle Aged
Treatment Outcome
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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