Carotid stenting in refractory carotid dissection

Abstract Objectives. We assessed the safety and efficiency of endovascular stent angioplasty treating carotid dissection in those patients who failed medical therapy. Methods. In five years we treated twenty-two patients with carotid dissection. The dissection was spontaneous in sixteen (72.7%) and post-traumatic in the remaining six (27.3%) including one bilateral. Twenty patients started anticoagulation therapy on diagnosis. Fourteen patients were treated with intravenous heparin and subsequently with oral anticoagulation. Carotid angioplasty with stent placement was carried out in six cases with recurrent ischemic events. Results: Anticoagulation therapy was attempted in 20 out of 22 cases while it was contraindicated in two patients due to open trauma of the neck (9%). Medical treatment was adequate to treat the carotid dissection in 14 patients (70%). In this group the degree of dissection-related stenosis improved from 60 ± 24% to 20 ± 5% in eight patients (56, 8%);the non-hemodynamic stenosis remained stable in four cases (24, 8%). In six cases (30%) of carotid dissection initially treated with anticoagulation therapy, carotidstent placement was necessary due to the persistence or recurrence of neurologic symptoms. All patients submitted to the endovascular or surgical management had an immediate improvement of their neurological symptoms with no procedure-related complications. Conclusion: carotid stent placement is effective in the prevention of recurrent neurological events in a non-negligible percentage of cases in which anticoagulation therapy fails. This experience, cancontribute with other similar studies to better define the role of carotid stenting compared to medical therapy in the management of carotid dissection