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Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature

Pham, Martin H BS*; Rahme, Rudy J MD*; Arnaout, Omar BS*; Hurley, Michael C MD*‡; Bernstein, Richard A MD, PhD§; Batjer, H Hunt MD*; Bendok, Bernard R MD*‡

Neurosurgery:
doi: 10.1227/NEU.0b013e318209ce03
Review: Editor's Choice
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.

Author Information

Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois

Received, February 10, 2010.

Accepted, August 16, 2010.

Correspondence: Bernard R. Bendok, MD, Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 2210, Chicago, IL 60611. E-mail: bbendok@nmff.org

Copyright © by the Congress of Neurological Surgeons