Clinical Neurology and Neuroscience
Volume 3, Issue 4, December 2019, Pages: 74-76
Received: Jul. 1, 2019;
Accepted: Aug. 3, 2019;
Published: Oct. 11, 2019
Views 439 Downloads 157
Mehrnoush Gorjian, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Scott B. Raymond, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Matthew Koch, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Aman B. Patel, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Background: Vertebral artery (VA) dissection causing acute stroke is commonly treated with anticoagulation and rarely requires stenting. While stenting for atherosclerotic stenosis of VA is an established and efficient treatment option, the safety of stenting for VA dissection has not been studied. Case information: We report the technical challenges associated with stenting of a proximal VA dissection in a 74 year-old male with NIHSSS > 20 outside of the time window for thrombolytic therapy presenting with acute basilar artery thrombus and a hypoplastic contralateral VA. Methods: A coronary Drug-Eluting Stent (DES) was implemented in right VA following balloon angioplasty and basilar artery thrombolysis to maintain the patency of the dissected area in proximal VA. Results: The procedure was completed without complication. Postoperative Digital Subtraction Angiography (DSA) confirmed the patency of the vertebrobasilar system. There was no evidence of significant residual stenosis in the right vertebral artery on the follow up Computed Tomography Angiography (CTA) 2 months after the stent placement. Conclusion: Endovascular stenting of proximal VA dissection in the setting of acute ischemic stroke is relatively safe and feasible. It could be particularly considered in patients ineligible for IV thrombolysis with a hypoplastic contralateral VA. Further studies are needed to evaluate the long-term safety and efficacy of stenting for VA dissection.
Scott B. Raymond,
Aman B. Patel,
Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke, Clinical Neurology and Neuroscience.
Vol. 3, No. 4,
2019, pp. 74-76.
Yoshimura S, Sakai N, Uchida K, Yamagami H, Ezura M, Okada Y, Kitagawa K, Kimura K, Sasaki M, Tanahashi N, Toyoda K, Furui E, Matsumaru Y, Minematsu K, Morimoto T. Endovascular Therapy in Ischemic Stroke With Acute Large-Vessel Occlusion: Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2. J Am Heart Assoc. 2018 Apr 25; 7 (9).
Pham, M. H., Rahme, R. J., Arnaout, O., Hurley, M. C., Bernstein, R. A., Batjer, H. H., Bendok, B. R. (2011). Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery, 68 4, 856-66; discussion 866.
el Nakadi B, Wery D, Bodson A. Vertebral artery dissection: case report. J Cardiovasc Surg (Torino). 1995; 36 (3): 247-249.
Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344: 898–906.
Peng, J., Liu, Z., Luo, C., Chen, L., Hou, X., Xiao, L., Zhou, Z. (2017). Treatment of Cervical Artery Dissection: Antithrombotics, Thrombolysis, and Endovascular Therapy. BioMed research international.
Markus HS, Larsson SC, Kuker W, Schulz UG, Ford I, Rothwell PM, et al. Stenting for symptomatic vertebral artery stenosis: the vertebral artery ischaemia stenting trial. Neurology. (2017) 89: 1229–36. doi: 10.1212/WNL.0000000000004385.
J. Y. Joo, J. Y. Ahn, Y. S. Chung et al., “Treatment of intra- and extracranial arterial dissections using stents and embolization,” CardioVascular and Interventional Radiology, vol. 28, no. 5, pp. 595–602, 2005.
Ortega-Gutiérrez, S., Lopez, G. V., Edgell, R. C., Mendez, A. A., Dandapat, S., Roa, J. A., Zevallos, C. B., Holcombe, A. L., Raper, D. M., Derdeyn, C. P., Rossen, J. D., Samaniego, E. A. (2019). Second Generation Drug-Eluting Stents for Endovascular Treatment of Ostial Vertebral Artery Stenosis: A Single Center Experience. Front. Neurol.
Langwieser N, Buyer D, Schuster T, Haller B, Laugwitz KL, Ibrahim T. "Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. " J Endovasc Ther. 21. 5 (2014): 683-692.
Kawaguchi M, Nii K, Sakamoto K, Kawahara K, Inoue R, Hiraoka F, Morinaga Y, Mitsutake T, Hanada H, Tsutsumi M. "[The Efficacy of Percutaneous Transluminal Angioplasty and Stenting for Traumatic Vertebral Artery Dissection due to Cervical Vertebral Fracture]. [Article in Japanese]." No Shinkei Geka. 46. 2 (2018): 133-138.
Fields JD, Lutsep HL, Rymer MR, Budzik RF, Devlin TG, Baxter BW, Malek R, Padidar AM, Barnwell SL, Smith WS and Merci Registry Investigators. "Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection." Interventional Neuroradiology 18. 1 (2012): 74-79.
Sawada T., Shite J., Shinke T., Watanabe S., Otake H., Matsumoto D., Imuro Y., Ogasawara D., Paredes O. L., and Yokoyama M. "Persistent malapposition after implantation of sirolimus-eluting stent into intramural coronary hematoma: optical coherence tomography observations." Circ. J. 70 (2006): 1515-1519.
Conrotto F, D'Ascenzo F, Cerrato E, Fernández-Ortiz A, Gonzalo N, Macaya F, Tamburino C, Barbanti M, van Lavieren M, Piek JJ, Applegate RJ, Latib A, Spinnler MT, Marzullo R, Iannaccone M, Pavani M, Crimi G, Fattori R, Chinaglia A, Presbitero P, Varbella F, Gaita F, Escaned J. "Safety and efficacy of drug eluting stents in patients with spontaneous coronary artery dissection." Int J Cardiol. 1. 238 (2017): 105-109.
Price MJ, Shlofmitz RA, Spriggs DJ, Haldis TA, Myers P, Popma Almonacid A, Maehara A, Dauler M, Peng Y, Mehran R. "Safety and efficacy of the next generation Resolute Onyx zotarolimus-eluting stent: Primary outcome of the RESOLUTE ONYX core trial." Catheter Cardiovasc Interv. (2017).
Piccolo R, Stefanini GG, Franzone A, Spitzer E, Blochlinger S, Heg D, et al. Safety and efficacy of resolute zotarolimus-eluting stents compared with everolimus-eluting stents: a meta-analysis. Circ Cardiovasc Intervent. (2015) 8: 4. doi: 10.1161/CIRCINTERVENTIONS.114.002223.