Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent.

Abstract

Endovascular stent reconstruction is the primary intervention for cervical and intracranial dissections in symptomatic patients refractory to medical management. Advancement of traditional balloon-expanding stents into the distal internal carotid artery and vertebrobasilar artery can be technically challenging and potentially traumatic. On retrospective review, nine patients at our institution with distal cervical and/or intracranial dissections were alternatively treated with the self-expanding, dedicated intracranial Neuroform stent. Three patients with dissecting aneurysms also required stent-assisted coil embolization. Seven patients were followed with imaging and clinical assessment for a mean of 16.3 months. All patients (five men, four women; mean age, 50 yr) were symptomatic. Spontaneous (n = 4) or traumatic and/or iatrogenic (n = 5) dissections involved the internal carotid artery (n = 2), vertebral artery (n = 5), and vertebrobasilar artery (n = 2). Indications for treatment included transient ischemic attacks, impending infarcts, antiplatelet failure, enlarging or ruptured dissecting aneurysms, intracranial dissections, or subarachnoid hemorrhages. Dissections were treated with single (n = 4), overlapping (n = 2), or tandem (n = 3) Neuroform stents. Dissection-related mean stenosis improved from 76% preprocedure to 23% postprocedure, with further reduction to 8% at follow-up imaging. Stent-assisted coil embolization of large dissecting aneurysms (n = 3) resulted in retreatment of a neck remnant (n = 1). Small dissecting aneurysms (n = 5) underwent spontaneous stent-induced thrombosis. There were no procedure-related complications. Mortality was limited to the presenting sequelae of vertebrobasilar artery thrombosis (n = 2). Suboptimal technical outcomes were related to delayed in-stent stenosis (n = 2). All surviving patients (n = 7) reported clinical improvement or resolution of symptoms. The Neuroform stent seems to be safe and technically effective in the endovascular management of distal cervical and intracranial dissections, with favorable clinical outcomes.