Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection

Jeremy D. Fields, Helmi Lutsep, M. R. Rymer, R. F. Budzik, T. G. Devlin, B. W. Baxter, R. Malek, A. M. Padidar, S. L. Barnwell, W. S. Smith

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Arterial dissections account for 2% of strokes in all age groups, and up to 25% in patients aged 45 years or younger. The safety of endovascular intervention in this patient population is not well characterized. We identified all patients in the Merci registry - a prospective, multi-center post-market database enrolling patients treated with the Merci Retriever thrombectomy device - with arterial dissection as the most likely stroke etiology. Stroke presentation and procedural details were obtained prospectively; data regarding procedural complications, intracerebral hemorrhage (ICH), and the use of stenting of the dissected artery were obtained retrospectively. Of 980 patients in the registry, ten were identified with arterial dissection (8/10 ICA; 2/10 vertebrobasilar). The median age was 48 years with a baseline NIH stroke scale score of 16 and median time to treatment of 4.9 h. The procedure resulted in thrombolysis in cerebral ischemia (TICI) scores of 2a or better in eight out of ten and TICI 2b or better in six out of ten patients. Stenting of the dissection was performed in four of nine (44%). The single complication (1/9; 11%) - extension of a dissected carotid artery - was treated effectively with stenting. No symptomatic ICH or stroke in a previously unaffectedterritory occurred. A favorable functional outcome was observed in eight out of ten patients. Despite severe strokes on presentation, high rates of recanalization (8/10) and favorable functional outcomes (8/10) were observed. These results suggest that mechanical thrombectomy in patients with acute stroke resulting from arterial dissection is feasible, safe, and may be associated with favorable functional outcomes.

Original languageEnglish (US)
Pages (from-to)74-79
Number of pages6
JournalInterventional Neuroradiology
Volume18
Issue number1
StatePublished - Mar 2012

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Thrombectomy
Dissection
Stroke
Cerebral Hemorrhage
Therapeutics
Brain Ischemia
Registries
Carotid Arteries
Arteries
Age Groups
Databases
Safety
Equipment and Supplies

Keywords

  • Acute stroke
  • Arterial dissection
  • Carotid dissection
  • Endovascular
  • Interventional
  • Mechanical thrombectomy
  • Stenting
  • Stroke
  • Vertebral dissection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Fields, J. D., Lutsep, H., Rymer, M. R., Budzik, R. F., Devlin, T. G., Baxter, B. W., ... Smith, W. S. (2012). Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection. Interventional Neuroradiology, 18(1), 74-79.

Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection. / Fields, Jeremy D.; Lutsep, Helmi; Rymer, M. R.; Budzik, R. F.; Devlin, T. G.; Baxter, B. W.; Malek, R.; Padidar, A. M.; Barnwell, S. L.; Smith, W. S.

In: Interventional Neuroradiology, Vol. 18, No. 1, 03.2012, p. 74-79.

Research output: Contribution to journalArticle

Fields, JD, Lutsep, H, Rymer, MR, Budzik, RF, Devlin, TG, Baxter, BW, Malek, R, Padidar, AM, Barnwell, SL & Smith, WS 2012, 'Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection', Interventional Neuroradiology, vol. 18, no. 1, pp. 74-79.
Fields, Jeremy D. ; Lutsep, Helmi ; Rymer, M. R. ; Budzik, R. F. ; Devlin, T. G. ; Baxter, B. W. ; Malek, R. ; Padidar, A. M. ; Barnwell, S. L. ; Smith, W. S. / Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection. In: Interventional Neuroradiology. 2012 ; Vol. 18, No. 1. pp. 74-79.
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AU - Devlin, T. G.

AU - Baxter, B. W.

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