Cohen José E, Gomori John M, Leker Ronen R, Ben-Hur Tamir, Grigoriadis Savvas, Rajz Gustavo
Department of Neurosurgery, Hadassah University Medical Center, Jerusalem, Israel.
Neurol Res. 2010 Apr;32(3):293-6. doi: 10.1179/174313209X382467.
Internal carotid artery dissections (ICADs) with occlusion present with a high morbidity and mortality. No specific medical treatment has proven to be effective in this setting. In selected cases of ICAD with occlusion, stent-assisted angioplasty has been shown to be effective in restoring the perfusion. Spontaneous ICAD causing occlusion successfully recanalized with multiple telescoped stents extending intracranially has only been reported exceptionally.
We report cases of symptomatic acute carotid occlusion after spontaneous dissection extending from the cervical to the petrocavernous ICA segments. Imaging studies revealed the presence of an extensive penumbra area in every case. Patients were treated by means of multiple stents deployed in a telescoped fashion with the aid of a delayed double-contrast road map.
Post-procedural angiography demonstrated restitution of the carotid lumen with no signs of residual dissection or intracranial emboli. The patients improved rapidly, showing no residual neurological deficit after a week. At follow-up, patients are clinically asymptomatic and the vessel is patent with no radiological signs of myointimal hyperplasia.
The successful angiographic and clinical results observed in our cases of extraintracranial stenting of a long carotid dissection causing occlusion contribute to the literature of carotid dissection treated with multiple stents.
伴有闭塞的颈内动脉夹层（ICADs）具有较高的发病率和死亡率。在这种情况下，尚无已证实有效的特异性药物治疗方法。在部分ICAD伴闭塞的病例中，支架辅助血管成形术已被证明可有效恢复灌注。自发性ICAD导致闭塞并通过多个颅内延伸的套叠式支架成功再通的情况仅偶有报道。
我们报告了从颈段至海绵窦段颈内动脉自发性夹层后出现症状性急性颈动脉闭塞的病例。影像学研究显示每个病例均存在广泛的半暗带区域。患者通过在延迟双对比路图辅助下以套叠方式部署多个支架进行治疗。
术后血管造影显示颈动脉管腔恢复，无残余夹层或颅内栓子迹象。患者恢复迅速，一周后无残余神经功能缺损。随访时，患者临床无症状，血管通畅，无肌内膜增生的放射学迹象。
我们对导致闭塞的长段颈动脉夹层进行颅外支架置入的病例所观察到的成功血管造影和临床结果，丰富了用多个支架治疗颈动脉夹层的文献资料。
