Long-term Clinical and Angiographic Outcomes in Patients with Spontaneous Cervico-Cranial Arterial Dissections Treated with Stent Placement

BACKGROUND Limited data exist regarding the long-term clinical and angiographic outcomes of patients with spontaneous cervico-cranial arterial dissection treated with stent placement. OBJECTIVE To report the immediate and long-term clinical and angiographic outcomes of patients who received stent placement for spontaneous cervico-cranial arterial dissection. Methods We reviewed clinical and angiographic data of consecutive patients with spontaneous, cervico-cranial arterial dissection treated with stent placement. Patients with recurrent ischemic symptoms or severe hemodynamic compromise despite maximal medical therapy, or those with compressive symptoms due to expanding pseudoaneurysms were considered for stent placement. Follow-up angiography and intravascular ultrasound (in select patients) was performed to detect in-stent restenosis, intimal flap, thrombus, or persistent pseudoaneurysm. RESULTS A total of 14 patients were identified, with complete resolution of stenosis achieved in 10 patients immediately post-procedure. Clinical follow-up ranged from 26900 days, during which there was 1 (7%) TIA, 1 (7%) minor ischemic stroke, and 1 (7%) in hospital death (unrelated to stent placement). Stroke-free survival was 93% at both 1 month and 6 months after the procedure. Follow-up angiography did not reveal any in-stent restenosis. CONCLUSIONS This study demonstrates the feasibility, safety, and intermediate term effectiveness of endovascular stent reconstruction of spontaneous, cervico-cranial arterial dissection.