Document Detail


Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection.
MedLine Citation:
PMID:  19756560     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. METHODS: A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. RESULTS: Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS < or = 1. CONCLUSION: Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection.
Authors:
Isabelle Mourand; Herve Brunel; Jean-Fran?ois Vendrell; Eric Thouvenot; Alain Bonaf?
Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-09-15
Journal Detail:
Title:  Neuroradiology     Volume:  52     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-25     Completed Date:  2010-03-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  135-40     Citation Subset:  IM    
Affiliation:
Department of Neurology, CHU Montpellier, H?pital Gui de Chauliac, 34295 Montpellier, Cedex 5, France. i-mourand@chu-montpellier.fr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease / therapy
Adult
Arterial Occlusive Diseases / pathology,  surgery,  therapy*
Brain / blood supply,  pathology,  surgery
Carotid Artery, Internal, Dissection / pathology,  surgery,  therapy*
Cerebral Angiography
Diffusion Magnetic Resonance Imaging
Female
Follow-Up Studies
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Recombinant Proteins / therapeutic use
Severity of Illness Index
Stents*
Stroke / pathology,  surgery,  therapy
Thrombolytic Therapy / instrumentation*,  methods*
Time Factors
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Recombinant Proteins; EC 3.4.21.68/Tissue Plasminogen Activator

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


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