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<meta name="DC.Title" content="Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2115" />
<meta name="DC.Date" content="2010-09-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.

MATERIALS AND METHODS: Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated.

RESULTS: All patients presented with progressive ( n = 6) or fluctuating ( n = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion ( n = 2) or critical stenosis ( n = 6) in intracranial ( n = 3) or extracranial ( n = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis.

CONCLUSIONS: Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.

ICA
:   internal carotid artery
ICAD
:   ICA dissection
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale" />
<meta name="DC.Contributor" content="P. Jeon" />
<meta name="DC.Contributor" content="B.M. Kim" />
<meta name="DC.Contributor" content="D.I. Kim" />
<meta name="DC.Contributor" content="Y.S. Shin" />
<meta name="DC.Contributor" content="K.H. Kim" />
<meta name="DC.Contributor" content="S.I. Park" />
<meta name="DC.Contributor" content="D.J. Kim" />
<meta name="DC.Contributor" content="S.H. Suh" />
<meta name="article:published_time" content="2010-09-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;All patients presented with progressive (&lt;i&gt;n&lt;/i&gt; = 6) or fluctuating (&lt;i&gt;n&lt;/i&gt; = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion (&lt;i&gt;n&lt;/i&gt; = 2) or critical stenosis (&lt;i&gt;n&lt;/i&gt; = 6) in intracranial (&lt;i&gt;n&lt;/i&gt; = 3) or extracranial (&lt;i&gt;n&lt;/i&gt; = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.&lt;/p&gt;" />
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<meta name="twitter:title" content="Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/31/8.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.

MATERIALS AND METHODS: Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated.

RESULTS: All patients presented with progressive ( n = 6) or fluctuating ( n = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion ( n = 2) or critical stenosis ( n = 6) in intracranial ( n = 3) or extracranial ( n = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis.

CONCLUSIONS: Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.

ICA
:   internal carotid artery
ICAD
:   ICA dissection
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale" />
<meta name="og-title" property="og:title" content="Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/8/1529" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.

MATERIALS AND METHODS: Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated.

RESULTS: All patients presented with progressive ( n = 6) or fluctuating ( n = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion ( n = 2) or critical stenosis ( n = 6) in intracranial ( n = 3) or extracranial ( n = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis.

CONCLUSIONS: Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.

ICA
:   internal carotid artery
ICAD
:   ICA dissection
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-series highwire-cite-metadata">E</span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">P. Jeon</span>, <span class="highwire-citation-author" data-delta="1">B.M. Kim</span>, <span class="highwire-citation-author" data-delta="2">D.I. Kim</span>, <span class="highwire-citation-author" data-delta="3">Y.S. Shin</span>, <span class="highwire-citation-author" data-delta="4">K.H. Kim</span>, <span class="highwire-citation-author" data-delta="5">S.I. Park</span>, <span class="highwire-citation-author" data-delta="6">D.J. Kim</span> and <span class="highwire-citation-author" data-delta="7">S.H. Suh</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">September 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1529-1532; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2115 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9805--61408961665" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">P. Jeon </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BJeon%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jeon%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BJeon%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B.M. 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<p id="p-4"><strong>BACKGROUND AND PURPOSE:</strong> ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency.</p>
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<p id="p-5"><strong>MATERIALS AND METHODS:</strong> Eight patients (7 men and 1 woman; age range, 20–55 years; NIHSS score, 5–21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated.</p>
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<p id="p-6"><strong>RESULTS:</strong> All patients presented with progressive (<em>n</em> = 6) or fluctuating (<em>n</em> = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion (<em>n</em> = 2) or critical stenosis (<em>n</em> = 6) in intracranial (<em>n</em> = 3) or extracranial (<em>n</em> = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5–21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8–50 months). Angiographic follow-up was available for 6 patients at 3–12 months. None of the 6 patients revealed residual or in-stent restenosis.</p>
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<p id="p-7"><strong>CONCLUSIONS:</strong> Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">ICAD<span class="def-item-dt-sep"></span></dt><dd>ICA dissection<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">NIHSS<span class="def-item-dt-sep"></span></dt><dd>National Institutes of Health Stroke Scale</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-3">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/8/1529.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 31</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Sep 2010 </div></div>
      
      
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      <div class="highwire-cite-title">Emergent Self-Expanding Stent Placement for Acute Intracranial or Extracranial Internal Carotid Artery Dissection with Significant Hemodynamic Insufficiency</div>  
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