REGULAR CONTENT
Final ID
582
Type
Educational Exhibit-Poster Only
Authors
P Davidson1, J Singh2
Institutions
1Wake Forest University Baptist Medical Center, Winston Salem, NC, 2N/A, Winston Salem, NC
Purpose
- Review the evolving role of stent placement as a primary therapy for acute phase ICA dissection- Provide a pictorial review of cases performed at our institution and briefly outline techniques- Identify patients who are candidates for intervention
Materials & Methods
Internal carotid artery (ICA) dissection may be spontaneous, traumatic, or iatrogenic. While often asymptomatic, symptoms related to flow limitation and distal emboli may be present. Arterial dissections account for a significant portion of the strokes seen in young patients (3). Anticoagulation has been the mainstay of therapy in the past as the pathogenesis has been thought to relate primarily to thromboembolism (2). While anticoagulation has a clear role in ICA dissection treatment, patients presenting with large vascular territory ischemia are candidates for stenting to restore flow and prevent infarct completion. A large randomized controlled trial has not been performed; however, systematic review of the literature and our own experience shows efficacy and safety (1,4).
Results
Procedure details will include techniques for microcatheterization of the true lumen and subsequent stent choice and deployment. Our algorithm for patient selection is reviewed. Patients presenting with ischemic symptoms, but demonstrating penumbra on CT perfusion imaging are candidates for emergent endovascular intervention. Dual antiplatelet therapy is initiated following a bridge with a fast acting agent such as Integrilin (eptifipatide). Excellent outcomes with reversal of symptoms such as hemiparesis have been achieved in some cases.
Conclusions
Patients with ICA dissection and ischemic symptoms who are found to have evidence of penumbra are candidates for emergent endovascular stenting. While larger studies are needed, review of the literature and our own experience shows promising results with satisfactory safety and efficacy.
Final ID
582
Type
Educational Exhibit-Poster Only
Authors
P Davidson1, J Singh2
Institutions
1Wake Forest University Baptist Medical Center, Winston Salem, NC, 2N/A, Winston Salem, NC
Purpose
- Review the evolving role of stent placement as a primary therapy for acute phase ICA dissection- Provide a pictorial review of cases performed at our institution and briefly outline techniques- Identify patients who are candidates for intervention
Materials & Methods
Internal carotid artery (ICA) dissection may be spontaneous, traumatic, or iatrogenic. While often asymptomatic, symptoms related to flow limitation and distal emboli may be present. Arterial dissections account for a significant portion of the strokes seen in young patients (3). Anticoagulation has been the mainstay of therapy in the past as the pathogenesis has been thought to relate primarily to thromboembolism (2). While anticoagulation has a clear role in ICA dissection treatment, patients presenting with large vascular territory ischemia are candidates for stenting to restore flow and prevent infarct completion. A large randomized controlled trial has not been performed; however, systematic review of the literature and our own experience shows efficacy and safety (1,4).
Results
Procedure details will include techniques for microcatheterization of the true lumen and subsequent stent choice and deployment. Our algorithm for patient selection is reviewed. Patients presenting with ischemic symptoms, but demonstrating penumbra on CT perfusion imaging are candidates for emergent endovascular intervention. Dual antiplatelet therapy is initiated following a bridge with a fast acting agent such as Integrilin (eptifipatide). Excellent outcomes with reversal of symptoms such as hemiparesis have been achieved in some cases.
Conclusions
Patients with ICA dissection and ischemic symptoms who are found to have evidence of penumbra are candidates for emergent endovascular stenting. While larger studies are needed, review of the literature and our own experience shows promising results with satisfactory safety and efficacy.