STENTING OF DISSECTED CAROTID ARTERIES AS A MINIMALLY INVASIVE TREATMENT MODALITY

Abstract

Aim: The purpose of this paper is to present our experiences with carotid artery stenting in the treatment of dissected carotid arteries, by means of self-expandable stents and selective employment of cerebral protection devices. Methods: In the period from June 1, 2006 to April 31, 2009, 6 patients with 6 dissected carotid arteries were treated with self-expandable stents (4 internal carotid artery dissections and 2 common carotid artery dissections). Two dissections were of spontaneous origin, 2 were traumatic, and 2 were iatrogenic. We applied cerebral protection filters selectively in 3 patients, based on morphological appearance of lesions. The criterion for the usage of protection devices was caudally oriented opening of the false lumen in order to prevent the possible migration of a thrombus from the false lumen during cranio-caudal deployment of self-expandable stents. We followed-up patients clinically and by means of duplex scanning throughout 12 months. Results: Primary technical success was 100%. During the 12-month follow-up period no clinical or morphological signs of treatment failure were recorded. None of the patients suffered any complication (cerebral vascular insult, transitory ischemic attack, in-stent stenosis or occlusion). Conclusion: Carotid stenting, with selective employment of cerebral protection devices, is a successful, minimally invasive, and low risk procedure in the treatment of carotid dissections in cases when conservative treatment does not bring improvement to local finding or patients’ general condition.