Initial clinical experience with Xpert-Pro peripheral self-expanding stent system for internal carotid artery dissection: Two case reports

Abstract

Background: The standard treatment for internal carotid artery (ICA) dissection is obscure. Current therapeutic strategies include the use of antiplatelet drugs, anticoagulant drugs, intravenous thrombolysis, and endovascular treatment. Endovascular treatment is important in acute internal carotid artery dissection. This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral self-expanding stent system.

Case summary: The first case was of a 38-year-old male patient with transient speechlessness and paralysis of the right limb in July 2021. Cervical computed tomographic angiography (CTA) showed ICA occlusion on the left side. Digital subtraction angiography (DSA) showed severe stenosis of the C1 segment of the left internal carotid artery with intermural hematoma. The patient subsequently underwent Xpert-Pro peripheral self-expanding stent implantation, and his condition stabilized. The second case was of a 56-year-old male patient with speechlessness and paralysis of the right limb. Cervical CTA showed a dissected left ICA, and DSA showed an occluded left ICA and middle cerebral artery. The patient subsequently underwent stent implantation, and his condition stabilized.

Keywords: Case report; Endovascular treatment; Internal carotid artery dissection; Neurology; Stent.

Fig. 1

A: Left cerebral perfusion was impaired in CTP; B: Left-side ICA occlusion (white arrow) in cervical computed tomographic angiography.

Fig. 2

A: DSA confirms left ICA occlusion; B: Confirmation of true lumen by microcatheter; C： Umbrella in position; D and E: The patient underwent Xpert-Pro stent endovascular therapy; white arrow shows the dense stent mesh; F: Three months later, cervical CTA showed that the shape of Xpert-Pro stent was normal.

Fig. 3

A: Cervical CTA (February 23, 2021) showed left ICA dissection (arrow); B left ICA (white triangle) and MCA (white arrow) occlusions in Cervical CTA (February 25, 2021); C: left cerebral perfusion was impaired in CTP (February 25, 2021).

Fig. 4

A: DSA confirms left ICA occlusion; B: Confirmation of true lumen by microcatheter; C and D: MCA recanalization after catalyst-6 aspiration catheter for embolization; E, F and G: The patient underwent Xpert-Pro stent endovascular therapy.