Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach.
J Neurointerv Surg
; 9(1): 11-16, 2017 Jan.
Article
en En
| MEDLINE
| ID: mdl-27422969
ABSTRACT
BACKGROUND:
Carotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy.OBJECTIVE:
To evaluate the results of endovascular treatment and clinical outcomes of patients with CD.METHODS:
A four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8.RESULTS:
Thirty-eight patients (mean age 46.6±13.5â years, 78.9% male, 84.2% spontaneous CD, 44.7% left CD and 26.3% bilateral CD) were analyzed. In 24 patients (63.2%) treatment was undertaken in the acute-phase CD (APCD). IV recombinant tissue plasminogen activator was administered in 7 (29.2%) APCD cases. The patients with APCD exhibited a high rate of successful revascularization (Thrombolysis In Cerebral Infarction ≥2b; 19 patients (79.2%)), a low risk of symptomatic intracranial hemorrhage (n=2 (8.3%)), and good global functional outcomes (modified Rankin Scale (mRS) ≤2; n=17 (70.8%)). Good recanalization correlated (p=0.001) with good clinical evolution (mRS ≤2) in the patients with APCD. Of the 14 patients with non-acute phase CD (NAPCD), seven were treated for pseudoaneurysm with multiple stents (six patients) or covered prostheses, with stenosis being treated in the remaining seven patients.CONCLUSIONS:
Endovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Enfermedades de las Arterias Carótidas
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Procedimientos Endovasculares
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Disección Aórtica
Tipo de estudio:
Observational_studies
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Risk_factors_studies
Límite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Neurointerv Surg
Año:
2017
Tipo del documento:
Article
País de afiliación:
España