Internal Carotid Artery Dissection Treated with C-Guard Stent

Abstract

Internal carotid dissection is the most common cause of stroke in the young population. Stroke, the presence of a pseudoaneurysm, and decreased artery lumen with cerebral flow impairment are indications for treatment. Medical therapy with antithrombotic drugs and endovascular therapy with stenting are the main available options. The C-Guard stent is an open cell mesh-covered dual layer stent that has been mainly used in cases of internal carotid artery stenosis with a post-operative reduction in stroke incidence. Thus, we present two cases of internal carotid artery dissections of the cervical segment treated with the open cell dual-layer C-Guard stent without complications.

Keywords

dissection - stent - pseudoaneurysm - anticoagulation - stroke - internal carotid artery - dual antiplatelet therapy

Publication History

Article published online:
28 April 2020

• References

• 1 Blum CA, Yaghi S. Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome. Arch Neurosci 2015; 2 (04) e26670
• 2 Robertson JJ, Koyfman A. Cervical artery dissections: a review. J Emerg Med 2016; 51 (05) 508-518
• 3 Henry M, Henry I. The micromesh stent: a superior design?. J Indian Coll Cardiol 2016; 6: 40-43
• 4 Mazzaccaro D, Occhiuto MT, Righini P, Malacrida G, Nano G. Initial experience with the inspire MD C-Guard stent in the treatment of carotid artery disease. J Cardiovasc Surg (Torino) 2016; 57 (03) 474-478
• 5 Zelenak K, Zelenakova J, DeRiggo J, Kurca E, Kantorova E, Polacek H. Treatment of cervical internal carotid artery spontaneous dissection with pseudoaneurysm and unilateral lower cranial nerves palsy by two silk flow diverters. Cardiovasc Intervent Radiol 2013; 36 (04) 1147-1150
• 6 Paraskevas KI, Batchelder AJ, Naylor AR. Fate of distal false aneurysms complicating internal carotid artery dissection: a systematic review. Eur J Vasc Endovasc Surg 2016; 52 (03) 281-286
• 7 Kasprzak D, Bojakowski K, Nowicki M, Zawadzki M, Andziak P. False aneurysms complicating internal carotid artery dissection. Vasc Endovascular Surg 2019; 53 (03) 259-263
• 8 Guillon B, Brunereau L, Biousse V, Djouhri H, Lévy C, Bousser M-G. Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology 1999; 53 (01) 117-122
• 9 Giorgianni A, Pellegrino C, Micieli C. et al. Endovascular treatment of extracranial internal carotid pseudoaneurysm: description of three cases. Surg J (N Y) 2016; 2 (02) e15-e18
• 10 Engelter ST, Traenka C, Lyrer P. Dissection of cervical and cerebral arteries. Curr Neurol Neurosci Rep 2017; 17 (08) 59
• 11 Peng J, Liu Z, Luo C. et al. Treatment of cervical artery dissection: antithrombotics, thrombolysis, and endovascular therapy. BioMed Res Int 2017; 2017: 3072098
• 12 Brzezicki G, Rivet DJ, Reavey-Cantwell J. Pipeline embolization device for treatment of high cervical and skull base carotid artery dissections: clinical case series. J Neurointerv Surg 2016; 8 (07) 722-728
• 13 Baptista-Sincos APW, Simplício AB, Sincos IR. et al. Flow-diverting stent in the treatment of cervical carotid dissection and pseudoaneurysm: review of literature and case report. Ann Vasc Surg 2018; 46: 372-379
• 14 Giorgianni A, Pozzi F, Pellegrino C. et al. Emergency placement of a flow diverter stent for an iatrogenic internal carotid artery injury during endoscopic pituitary surgery. World Neurosurg 2019; 122: 376-379
• 15 To CY, Badr Y, Richards B. Treatment of acute cervical internal carotid artery dissection using the Solitaire FR revascularization device. J Neurointerv Surg 2013; 5 (06) e50
• 16 Wissgott C, Schmidt W, Brandt-Wunderlich C, Behrens P, Andresen R. Clinical results and mechanical properties of the carotid CGUARD double-layered embolic prevention stent. J Endovasc Ther 2017; 24 (01) 130-137
• 17 Briganti F, Tortora F, Volpe A, Elefante A, De Notaris M, Panagiotopoulos K. Stent implantation for treatment of symptomatic spontaneous cervical internal carotid artery dissecting aneurysm. A case report. Minim Invasive Neurosurg 2005; 48 (05) 306-309
• 18 Ahlhelm F, Benz RM, Ulmer S, Lyrer P, Stippich C, Engelter S. Endovascular treatment of cervical artery dissection: ten case reports and review of the literature. Intervent Neurol 2013; 1 (3-4): 143-150
• 19 Gray WA, Levy E, Bacharach JM. et al. Evaluation of a novel mesh-covered stent for treatment of carotid stenosis in patients at high risk for endarterectomy: 1-year results of the SCAFFOLD trial. Catheter Cardiovasc Interv 2019
• 20 Ruffino MA, Faletti R, Bergamasco L, Fonio P, Righi D. Incidence of new ischaemic brain lesions after carotid artery stenting with the micromesh roadsaver carotid artery stent: a prospective single-centre study. Cardiovasc Intervent Radiol 2016; 39 (11) 1541-1549
• 21 Diaz O, Lopez G, Roehm Jr JOF, De la Rosa G, Orozco F, Almeida R. The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release. J Neurointerv Surg 2018; 10 (02) 133-136
• 22 Mutzenbach SJ, Millesi K, Roesler C. et al. The Casper Stent System for carotid artery stenosis. J Neurointerv Surg 2018; 10 (09) 869-873
• 23 Broussalis E, Griessenauer C, Mutzenbach S. et al. Reduction of cerebral DWI lesion burden after carotid artery stenting using the CASPER stent system. J Neurointerv Surg 2019; 11 (01) 62-67
• 24 Schofer J, Musiałek P, Bijuklic K. et al. A prospective, multicenter study of a novel mesh-covered carotid stent: the CGuard CARENET trial (Carotid Embolic Protection Using MicroNet). JACC Cardiovasc Interv 2015; 8 (09) 1229-1234
• 25 Musialek P, Mazurek A, Trystula M. et al. Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard MicroNet-covered embolic prevention stent system. EuroIntervention 2016; 12 (05) e658-e670