Occurrence and Prognostic Significance of Pseudodissection Phenomenon Associated with Acute Distal Internal Carotid Artery Occlusion (P07.011)

Abstract

Objective: To determine the angiographic characteristics of the phenomemon of “pseudodissection” and its clinical implications in acute stroke endovascular treatment. Background Acute stroke from intracranial internal carotid artery (ICA) occlusion can occasionally resemble angiographic cervical ICA dissection which may cause delays in endovascular acute stroke treatment. Design/Methods: Retrospective analysis of angiographic and clinical data of 31 patients with acute stroke from ICA occlusion, treated with endovascular therapy at two University affiliated institutions was performed. Pseudodissection was defined as angiographic appearance of typical ICA dissection with evidence of normal inner vascular wall upon further catheter exploration. Results: Angiographic appearance pseudodissection was identified in 7 out of 31 patients (22.6%). Six patients had guide catheters placed proximal to pseudodissection in anticipation of stent placement for treatment of dissection. All 7 patients had further exploration of the presumed dissected segment (6 microcatheter, 1 diagnostic catheter) which demonstrated normal vascular inner wall. The location of the clot was more common in the petro-cavernous segment in the pseudodissection patients (5/7, 71%). Carotid terminus clot was more common in non pseudodissection patients compared to pseduodissection patients (18/24, 75% versus 2/7, 29% respectively, p Conclusions: Early recognition of pseudodissection in the ICA is important in the setting of acute stroke to avoid delay in treatment of intracranial ICA occlusion. Disclosure: Dr. Siddiq has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Khatri has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Qureshi has nothing to disclose.