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Mechanical recanalization of acute carotid terminus occlusion from traumatic arterial dissection.

Chen M - Front Neurol (2010)

Bottom Line: In the setting of an acute stroke caused by arterial dissection, navigating a microcatheter and microguidewire past the dissected artery to gain access to the distal thromboembolic lesion may exacerbate the underlying pathology.We review a case report whereby successful recanalization of an acute carotid terminus occlusion due to intimal-media dissection in the cervical carotid artery emphasizing the importance of aggressive proximal guide catheter aspiration in conjunction with flow arrest from the carotid bulb proximal to the dissection.We discuss the strengths and limitations of this approach and underscore the importance of a pathology-based approach to acute stroke therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, Rush University Medical Center Chicago, IL, USA.

ABSTRACT
In the setting of an acute stroke caused by arterial dissection, navigating a microcatheter and microguidewire past the dissected artery to gain access to the distal thromboembolic lesion may exacerbate the underlying pathology. We review a case report whereby successful recanalization of an acute carotid terminus occlusion due to intimal-media dissection in the cervical carotid artery emphasizing the importance of aggressive proximal guide catheter aspiration in conjunction with flow arrest from the carotid bulb proximal to the dissection. We discuss the strengths and limitations of this approach and underscore the importance of a pathology-based approach to acute stroke therapy.

No MeSH data available.


Related in: MedlinePlus

Right lateral common carotid digital subtraction angiography cervical view showing an intimal flap and smooth tapered cervical carotid dissection extending up to the cervical/petrous junction.
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Figure 1: Right lateral common carotid digital subtraction angiography cervical view showing an intimal flap and smooth tapered cervical carotid dissection extending up to the cervical/petrous junction.

Mentions: Initial cervical carotid catheter angiography revealed a right posterior cervical carotid intimal flap indicating an intimal-media arterial dissection (Figure 1). Cerebral views showed delayed anterograde filling in the internal carotid artery associated with a carotid terminus occlusion (Figure 2). Attempts at advancing a Penumbra 41 reperfusion catheter (Penumbra Inc, Alameda, CA, USA) intracranially were unsuccessful because the edge of the reperfusion catheter could not be advanced past the dissection flap at the distal cervical carotid artery (Figure 3). Subsequent angiography showed a more proximal occlusive lesion, suggesting that the intimal flap had extended into the petrous carotid with further compromise of the luminal diameter (Figure 4).


Mechanical recanalization of acute carotid terminus occlusion from traumatic arterial dissection.

Chen M - Front Neurol (2010)

Right lateral common carotid digital subtraction angiography cervical view showing an intimal flap and smooth tapered cervical carotid dissection extending up to the cervical/petrous junction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008916&req=5

Figure 1: Right lateral common carotid digital subtraction angiography cervical view showing an intimal flap and smooth tapered cervical carotid dissection extending up to the cervical/petrous junction.
Mentions: Initial cervical carotid catheter angiography revealed a right posterior cervical carotid intimal flap indicating an intimal-media arterial dissection (Figure 1). Cerebral views showed delayed anterograde filling in the internal carotid artery associated with a carotid terminus occlusion (Figure 2). Attempts at advancing a Penumbra 41 reperfusion catheter (Penumbra Inc, Alameda, CA, USA) intracranially were unsuccessful because the edge of the reperfusion catheter could not be advanced past the dissection flap at the distal cervical carotid artery (Figure 3). Subsequent angiography showed a more proximal occlusive lesion, suggesting that the intimal flap had extended into the petrous carotid with further compromise of the luminal diameter (Figure 4).

Bottom Line: In the setting of an acute stroke caused by arterial dissection, navigating a microcatheter and microguidewire past the dissected artery to gain access to the distal thromboembolic lesion may exacerbate the underlying pathology.We review a case report whereby successful recanalization of an acute carotid terminus occlusion due to intimal-media dissection in the cervical carotid artery emphasizing the importance of aggressive proximal guide catheter aspiration in conjunction with flow arrest from the carotid bulb proximal to the dissection.We discuss the strengths and limitations of this approach and underscore the importance of a pathology-based approach to acute stroke therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, Rush University Medical Center Chicago, IL, USA.

ABSTRACT
In the setting of an acute stroke caused by arterial dissection, navigating a microcatheter and microguidewire past the dissected artery to gain access to the distal thromboembolic lesion may exacerbate the underlying pathology. We review a case report whereby successful recanalization of an acute carotid terminus occlusion due to intimal-media dissection in the cervical carotid artery emphasizing the importance of aggressive proximal guide catheter aspiration in conjunction with flow arrest from the carotid bulb proximal to the dissection. We discuss the strengths and limitations of this approach and underscore the importance of a pathology-based approach to acute stroke therapy.

No MeSH data available.


Related in: MedlinePlus