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Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature.
MedLine Citation:
PMID:  21242839     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Carotid and vertebral artery dissections are one of the leading causes of stroke in young individuals. OBJECTIVE:: To examine the published safety and efficacy of endovascular stenting for extracranial artery dissection. METHODS:: We conducted a systematic review of the literature to identify all cases of endovascular management of extracranial carotid and vertebral artery dissections. RESULTS:: For carotid dissections, our review yielded 31 published reports comprising 140 patients (153 vessels). Reported etiologies were traumatic (48%, n=64), spontaneous (37%, n=49), and iatrogenic (16%, n=21). The technical success rate of stenting was 99% and the procedural complication rate was 1.3%. Mean angiographic follow-up was 12.8 months (range 2-72) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range 1-72) and neurologic events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports comprising 10 patients (12 vessels). Etiologies were traumatic (60%, n=6), spontaneous (20%, n=2), and iatrogenic (20%, n=2). There was a 100% technical success rate. The mean angiographic follow-up period was 7.5 months (range from 2-12 months). No new neurologic events were reported during a mean clinical follow-up period of 26.4 months (range between 3 and 55 months). CONCLUSION:: Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared to medical management are needed to further elucidate the role of stenting.
Authors:
Martin H Pham; Rudy J Rahme; Omar Arnaout; Michael C Hurley; Richard A Bernstein; H Hunt Batjer; Bernard R Bendok
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-13
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, IL 60611 2Department of Radiology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, IL 60611 3Department of Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, IL 60611.
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