Document Detail


Symptomatic spontaneous intracranial carotid artery dissection treated with a self-expanding intracranial nitinol stent: a case report.
MedLine Citation:
PMID:  18313734     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although extracranial carotid dissection with stroke is common, intracranial dissection with stroke is rare. Stenting has been used to treat extracranial carotid dissections. Intracranially, however, it is only recently that stents have become a feasible option for this disease. We present a case of a spontaneous intracranial CAD with progressive symptoms despite medical management treated with a self-expanding intracranial micronitinol stent. CASE DESCRIPTION: A 47-year-old, right-handed woman presented to the emergency department after noticing left-sided face and arm weakness and numbness, along with slurred speech. The patient was started on aspirin 325 mg/d orally and lovenox 40 mg/d subcutaneously. On hospital day 2, the patient was noted to have repeated episodes of weakness and numbness on the left side and MRI evidence of a new stroke. A diagnostic cerebral angiogram from a selective right internal carotid injection revealed a flow-limiting stenosis secondary to a dissection of the supraclinoid internal carotid artery with severe flow limitation to the hemisphere. Endovascular management was decided on, and a Neuroform stent measuring 4.5 x 20 mm (Boston Scientific Corporation, Natick, Mass) was deployed across the dissection with significant improvement of flow to that hemisphere on the poststent angiogram. CONCLUSIONS: This case illustrates the successful off-label use of a self-expanding intracranial nitinol stent to treat a symptomatic intracranial internal CAD in the setting of failure of traditional medical management. This is a promising application of novel endovascular technology.
Authors:
Daniel L Surdell; Richard A Bernstein; Ziad A Hage; H Hunt Batjer; Bernard R Bendok
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-03-03
Journal Detail:
Title:  Surgical neurology     Volume:  71     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-23     Completed Date:  2009-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  604-9     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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MeSH Terms
Descriptor/Qualifier:
Alloys / therapeutic use
Anticoagulants / therapeutic use
Brain / blood supply,  pathology,  physiopathology
Brain Ischemia / etiology,  pathology,  surgery
Carotid Artery, Internal / pathology*,  radiography,  surgery*
Carotid Artery, Internal, Dissection / complications,  pathology*,  surgery*
Cerebral Angiography
Female
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Stents*
Stroke / etiology,  pathology,  surgery
Treatment Outcome
Vascular Surgical Procedures / instrumentation*,  methods
Chemical
Reg. No./Substance:
0/Alloys; 0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 52013-44-2/nitinol

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


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