Stent placement for intracranial internal carotid artery dissection presenting with ischemic stroke

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Objective: Intracranial internal carotid artery (IICA) dissection manifesting as an ischemic stroke is a rare phenomenon, for which the optimal treatment has not yet been established. We report 3 cases, each treated successfully with stent placement.Methods: The data of 3 consecutive patients with IICA dissection treated with stent placement were retrospectively reviewed.Results: The indications for stent placement were impending extensive infarct (n = 2) and recurrent ischemic attack during antithrombotic treatment (n = 1). All dissections were treated with balloon-expandable coronary stents. In all 3 cases, dissection-related vessel abnormalities were resolved after stent placement. No recurrent strokes were observed during the follow-up period (mean, 38.7 months). All cases had excellent or good clinical outcomes at the end of the follow-up. Follow-up angiography showed healing of dissection segments in all patients, without any restenoses. Case 1 was a 28-year-old male patient who presented with progressive hemiparesis on the left side after a sudden headache. A magnetic resonance imaging (MRI) diffusion-weighted image (DWI) showed infarcts in the territory of the right ICA; angiography showed high-grade stenosis and a double lumen in the right supraclinoid ICA. A balloon-expandable coronary stent was placed 4 hours after the onset of symptoms; the stenosis was completely resolved after stenting. Follow-up angiography performed 48 months later showed complete healing of the dissection. The patient had persistent but mild left arm monoparesis. Case 2 was a 29-year-old female patient who presented with hemiparesis on the left side after a seizure. MRI-DWI showed infarcts in the right basal ganglia. Angiography showed a 'pearl and string' sign in the right supraclinoid ICA. Anticoagulant therapy was initiated, and her symptoms resolved. The hemiparesis on the left side recurred; however, 4 days after the initial onset, her DWI revealed a new infarct. Stent placement was performed. Angiography obtained 44 months later showed complete healing of the dissection. The patient's residual symptoms at the conclusion of follow-up were limited to mild monoparesis of the left arm. Case 3 was a 17-year-old male patient who presented with severe right hemiplegia and total aphasia after a sudden headache. MRI revealed a diffusion-perfusion mismatch in the territory of the left ICA, and angiography showed high-grade long segment stenosis in the left supraclinoid ICA. Stent placement was performed 10.5 hours after the onset of symptoms and a complete resolution of the stenosis was achieved. Follow-up angiography obtained 24 months later showed complete healing of the dissection, with residual numbness of the right forearm, the only symptom.Conclusion: Our case series indicates that stent placement may be an effective treatment for intracranial ICA dissection presenting with ischemic stroke.

Stent placement for intracranial internal carotid artery dissection presenting with ischemic stroke

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