Burcu Oktay MD , Sadık Ardıç MD, Hikmet Firat MD, Erdem Akbal MD, Ramazan Akdemir MD
Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan...
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Reconstruction of Tortuous Cervical Internal Carotid Artery Dissection
with Pipeline Stent
Ahsan Sattar, MD, and Brian-Fred Fitzsimmons, MD
Neurointerventional Fellow
Medical College of Wisconsin
Case
• 73-year-old Caucasian male presented with acute right middle cerebral artery (MCA) stroke symptoms.
• NIHSS 2 • IV tPA • NICU admission overnight • Over the next 24-36 hours he started to decline
neurologically with worsening left sided weakness.
• Day 2 NIHSS 11
CTA Neck
Cervical ICA AP and Lateral
PED Deployment
Second PED Deployment
Cervical ICA AP and Lateral
Cerebral Angiogram Post PED Deployment
Post Thrombectomy Cerebral Angiogram
Post Thrombectomy
Eighteen months follow up
Conclusion
• Endovascular stent reconstruction of very tortuous cervical internal carotid artery (ICA) dissections remains a challenging procedure.
• The presence of a 360-degree loop in the ICA makes the use of traditional carotid stents arduous.
• The use of the Pipeline embolization device (PED), which is primarily approved for wide neck intracranial aneurysms, could be an alternative stent for use in such ICA dissection treatment.
Nelson, P. K., Lylyk, P., Szikora, I., Wetzel, S. G., Wanke, I., & Fiorella, D. (2011). The pipeline embolization device for the intracranial treatment of aneurysms trial. American Journal of Neuroradiology, 32(1), 34–40. doi:10.3174/ajnr.A2421
Thanks