Endovascular management of spontaneous carotid artery dissection.

OBJECTIVE Despite medical therapy, a subset of patients with spontaneous carotid artery dissection (SCD) experience recurrent or progressive symptoms. In this study, we assessed the safety and efficacy of endovascular stent angioplasty in the treatment of SCD. METHODS Seven consecutive patients with SCD underwent endovascular stent angioplasty of a total of 12 vessels. Indications included the presence of a large or enlarging pseudoaneurysm, a contraindication to anticoagulation, failure of anticoagulation, and compromised cerebral blood flow. RESULTS Five patients had fibromuscular dysplasia. All patients tolerated the procedure well, with no adverse clinical events. All patients showed symptomatic improvement on clinical follow-up except for one patient, who had hemorrhagic conversion of a pre-existing large ischemic stroke 13 days after intervention; he made an eventual recovery to baseline. All stents have remained patent on radiologic follow-up. CONCLUSIONS This study provides additional evidence that endovascular stent angioplasty is a safe and effective treatment for SCD in patients for whom medical treatment is not adequate.