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Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke

Received: 1 July 2019     Accepted: 3 August 2019     Published: 11 October 2019
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Abstract

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.

Published in Clinical Neurology and Neuroscience (Volume 3, Issue 4)
DOI 10.11648/j.cnn.20190304.11
Page(s) 74-76
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Vertebral Artery, Drug-Eluting Stent, Stroke

References
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[2] 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.
[3] el Nakadi B, Wery D, Bodson A. Vertebral artery dissection: case report. J Cardiovasc Surg (Torino). 1995; 36 (3): 247-249.
[4] Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344: 898–906.
[5] 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.
[6] 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.
[7] 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.
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Cite This Article
  • APA Style

    Mehrnoush Gorjian, Scott B. Raymond, Matthew Koch, Aman B. Patel. (2019). Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke. Clinical Neurology and Neuroscience, 3(4), 74-76. https://doi.org/10.11648/j.cnn.20190304.11

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    ACS Style

    Mehrnoush Gorjian; Scott B. Raymond; Matthew Koch; Aman B. Patel. Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke. Clin. Neurol. Neurosci. 2019, 3(4), 74-76. doi: 10.11648/j.cnn.20190304.11

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    AMA Style

    Mehrnoush Gorjian, Scott B. Raymond, Matthew Koch, Aman B. Patel. Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke. Clin Neurol Neurosci. 2019;3(4):74-76. doi: 10.11648/j.cnn.20190304.11

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  • @article{10.11648/j.cnn.20190304.11,
      author = {Mehrnoush Gorjian and Scott B. Raymond and Matthew Koch and Aman B. Patel},
      title = {Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke},
      journal = {Clinical Neurology and Neuroscience},
      volume = {3},
      number = {4},
      pages = {74-76},
      doi = {10.11648/j.cnn.20190304.11},
      url = {https://doi.org/10.11648/j.cnn.20190304.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20190304.11},
      abstract = {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.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Endovascular Stenting of Vertebral Artery Dissection in Acute Ischemic Stroke
    AU  - Mehrnoush Gorjian
    AU  - Scott B. Raymond
    AU  - Matthew Koch
    AU  - Aman B. Patel
    Y1  - 2019/10/11
    PY  - 2019
    N1  - https://doi.org/10.11648/j.cnn.20190304.11
    DO  - 10.11648/j.cnn.20190304.11
    T2  - Clinical Neurology and Neuroscience
    JF  - Clinical Neurology and Neuroscience
    JO  - Clinical Neurology and Neuroscience
    SP  - 74
    EP  - 76
    PB  - Science Publishing Group
    SN  - 2578-8930
    UR  - https://doi.org/10.11648/j.cnn.20190304.11
    AB  - 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.
    VL  - 3
    IS  - 4
    ER  - 

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Author Information
  • Department of Neurosurgery, Massachusetts General Hospital, Boston, USA

  • Department of Neurosurgery, Massachusetts General Hospital, Boston, USA

  • Department of Neurosurgery, Massachusetts General Hospital, Boston, USA

  • Department of Neurosurgery, Massachusetts General Hospital, Boston, USA

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