Endovascular stenting of extracranial carotid and vertebral artery dissections: A systematic review of the literature

Martin H. Pham, Rudy J. Rahme, Omar Arnaout, Michael C. Hurley, Richard A. Bernstein, H. Hunt Batjer, Bernard Bendok

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

BACKGROUND: Carotid and vertebral artery dissections are a leading cause 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 including 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 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 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, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 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 with medical management are needed to further elucidate the role of stenting.

Original languageEnglish (US)
Pages (from-to)856-866
Number of pages11
JournalNeurosurgery
Volume68
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

Fingerprint

Vertebral Artery Dissection
Carotid Arteries
Dissection
Case Management
Stents
Pathologic Constriction
Arteries
Stroke
Safety

Keywords

  • Carotid
  • Dissection
  • Endovascular
  • Extracranial artery
  • Stent
  • Vertebral

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Endovascular stenting of extracranial carotid and vertebral artery dissections : A systematic review of the literature. / Pham, Martin H.; Rahme, Rudy J.; Arnaout, Omar; Hurley, Michael C.; Bernstein, Richard A.; Batjer, H. Hunt; Bendok, Bernard.

In: Neurosurgery, Vol. 68, No. 4, 04.2011, p. 856-866.

Research output: Contribution to journalArticle

Pham, Martin H. ; Rahme, Rudy J. ; Arnaout, Omar ; Hurley, Michael C. ; Bernstein, Richard A. ; Batjer, H. Hunt ; Bendok, Bernard. / Endovascular stenting of extracranial carotid and vertebral artery dissections : A systematic review of the literature. In: Neurosurgery. 2011 ; Vol. 68, No. 4. pp. 856-866.
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AU - Pham, Martin H.

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AU - Arnaout, Omar

AU - Hurley, Michael C.

AU - Bernstein, Richard A.

AU - Batjer, H. Hunt

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N2 - BACKGROUND: Carotid and vertebral artery dissections are a leading cause 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 including 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 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 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, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 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 with medical management are needed to further elucidate the role of stenting.

AB - BACKGROUND: Carotid and vertebral artery dissections are a leading cause 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 including 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 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 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, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 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 with medical management are needed to further elucidate the role of stenting.

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KW - Endovascular

KW - Extracranial artery

KW - Stent

KW - Vertebral

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