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

Michael Chen

doi:10.3389/fneur.2010.00123

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.

Highlights

Arterial dissection is the second leading cause of stroke in patients younger than age 45 (Lisovoski and Rousseaux, 1991)
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

Summary

Michael Chen*

Medical College of Wisconsin and Froedtert Hospital, USA. Medical College of Wisconsin and Froedtert Hospital, USA Aamir Badruddin, Medical College of Wisconsin, USA Thanh Nguyen, Boston Medical Center, USA Jose R. 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

Introduction

Acute recanalization from arterial dissection

Discussion

Conclusion