The diagnosis and endovascular stent implantation treatment of spontaneous extracranial internal carotid artery dissection: initial experience of eight cases

Objective: To evaluate the therapeutic safety and efficacy of endovascular stent implantation in treating spontaneous extracranial internal carotid artery dissection. Methods: During the period from January 2012 to September 2013, eight patients with angiography-proved symptomatic spontaneous extracranial internal carotid artery dissection were admitted to author' hospital. All the patients had to receive endovascular stent implantation after they failed to respond to antithrombotic therapy. The clinical data were retrospectively analyzed. Results: Endovascular stent implantation was successfully accomplished in all the 8 patients. During the procedure additional protective umbrella was employed in 2 cases although no complications occurred. Cerebral angiography performed immediately after the procedure showed that the extracranial internal carotid stenosis caused by the dissection basically disappeared after stenting. Distal arterial occlusion occurred after pre-dilation with balloon in 2 patients, and the blood flow returned to normal after prompt stent implantation, leaving only 10%-20% residual stenosis. In the remaining other 6 patients, no in-stent restenosis occurred during the follow-up period lasting for half a year. Conclusion: For the treatment of spontaneous extracranial internal carotid artery dissection, endovascular stent implantation is safe and effective. Precise judgment of the site of stenosis, careful manipulation of balloon pre-dilation and the use of protective umbrella are the key points to ensure a successful treatment. (authors)