• Youngsoo Kim, Chang Hwa Choi, Tae Hong Lee, Han Jin Cho, Sang Min Sung, Seung Kug Baik, and Jun Kyeung Ko.
• Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
• World Neurosurg. 2017 Jun 1; 102: 598-607.

ObjectiveTo date, no controlled studies on the treatment of carotid artery dissection (CAD) have been reported. The purpose of this study was to demonstrate the technical feasibility and clinical efficacy of stent-supported angioplasty (SSA) as primary treatment for acute stroke due to CAD.MethodsA review of medical records identified 21 patients who underwent SSA as primary treatment for acute stroke related to CAD between 2008 and 2014. The inclusion criteria were recent transient ischemic attack (n = 7, 33.3%) or acute infarct (n = 14, 66.7%) due to CAD (≥70% narrowing) with hemodynamic impairment. Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.ResultsSSA was technically successful in all patients. Of 21 patients, 8 (38.1%) showed an additional intracranial occlusion. Intracranial recanalization to a thrombolysis in cerebral infarction ≥2b flow was achieved in 50% of the cases. Procedure-related mortality was 4.8%, and morbidity was 9.5%. Five (35.7%) of 14 patients presenting with an acute infarct showed significant improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 points compared with admission score) at 7 days after SSA. During the observation period (mean, 20.5 months), stroke recurrence occurred in only 1 patient (5%), resulting in an annual stroke risk of 2.9%. A favorable outcome (modified Rankin Scale score ≤2) was achieved in all 7 patients with a transient ischemic attack (100%) and in 7 of 14 patients with an acute infarct (50%) at the 90-day follow-up.ConclusionOur results provide evidence that SSA is a feasible and effective strategy as primary treatment for steno-occlusive CAD patients with significant hypoperfusion or a large penumbra.Copyright © 2017 Elsevier Inc. All rights reserved.

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