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

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: The Neuroform stent seems to be safe and technically effective in the endovascular management of distal cervical and intracranial dissections, with favorable clinical outcomes.