Extracranial Internal Carotid Artery Research Articles

Pericarotid Adipose Tissue is Associated with Circulatory Markers of Inflammation and Carotid Atherosclerosis.

Perivascular adipose tissue plays roles in vascular inflammation and atherosclerosis. The present study aimed to evaluate the association between pericarotid fat density (PFD) and circulatory inflammatory indicators, internal carotid artery (ICA) stenosis, and vulnerable carotid plaques. We retrospectively screened 498 consecutive patients who underwent both computed tomography angiography of the neck between January 2017 and December 2020. The PFD, ICA stenosis, and vulnerable carotid plaques were analyzed using established approaches. Laboratory data including C-reactive protein (CRP) levels, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were recorded. PFD was positively correlated with CRP, NLR, PLR, and SII, and negatively correlated with LMR. A higher PFD was independently associated with extracranial ICA stenosis (1.179 [1.003-1.387], P = .040) and vulnerable carotid plaques (1.046 [1.021-1.072], P = .001) after adjusting for systemic inflammatory indicators. These findings suggested higher PFD is independently associated with circulating inflammatory indicators, extracranial ICA stenosis, and vulnerable carotid plaque.

Lower Cranial Neuropathies as Presenting Symptom of Distal Extracranial Internal Carotid Artery Dissection Leading to Delay in Diagnosis and Treatment (P7-5.030)

Lower Cranial Neuropathies as Presenting Symptom of Distal Extracranial Internal Carotid Artery Dissection Leading to Delay in Diagnosis and Treatment (P7-5.030)

Extracranial Carotid Artery Aneurysm: An Institutuinal Review

Abstract Background: Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA. Materials and Methods: A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected. Results: A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment. Conclusion: ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.

Evaluating Total Atherosclerosis Burden of Baroreceptor-Resident Arteries after Ischemic Cerebrovascular Disease for Identifying Patients with Heavy Coronary Atherosclerosis Burden.

The carotid sinuses and aortic arch are baroreceptor-resident arteries (BRAs) and atherosclerosis-susceptible sites of brain-supplying arteries, which would impair baroreflex-mediated blood pressure (BP) regulation and prompt coronary atherosclerosis. We sought to determine the relationship between total atherosclerosis burden (TAB) of BRAs and coronary atherosclerosis burden (AB) in patients with ischemic cerebrovascular disease (ICVD) and explore the potential contribution of BP profiles to this relationship. In this cross-sectional analysis of patients with ICVD who simultaneously undertook computed tomography angiography and 24-hour ambulatory BP monitoring, TAB of BRAs was scored based on the atherosclerotic vessel circumference ratio of the carotid sinuses and aortic arch, while the ABs of the intracranial, cervical, aortic, and coronary arteries were scored based on stenosis severity and plaque complexity as routine. Among the 230 patients analyzed, coronary AB was significantly correlated with TAB of BRAs, independently of, and more tightly than the ABs of the intracranial, cervical, and aortic arteries, and the stenosis- and complexity-based AB of BRA-located arteries (bilateral common and extracranial internal carotid arteries and aortic arch). Both coronary AB and TAB of BRAs were negatively associated with the night-to-day BP dipping ratios, which was quite different from the relationship between intracranial AB and 24-hour BP characteristics. These findings were also true for patients with ICVD without a history of coronary artery disease. Evaluating TAB of BRAs might provide a new link between atherosclerosis of brain- and heart-supplying arteries, connected partially by BP circadian rhythm. It might facilitate identifying patients with ICVD with heavy coronary AB and comprehensively managing vascular risk.

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note.

Surgery is effective for extracranial internal carotid artery (EICA) aneurysms. However, the risk of cranial nerve injury associated with surgical repair, such as graft-assisted resection and extracranial-intracranial bypass techniques, is relatively high. Here, we report two cases of surgical treatment for EICA aneurysms and describe the surgical techniques and strategies to avoid cranial nerve injury. Two patients presented to our facility with an increasing cervical pulsatile mass and no neurological symptoms. Angiography showed a large aneurysm in the cervical internal carotid artery. Surgical treatment was performed to prevent rupture of the aneurysm. In both patients, the aneurysm was strongly attached to the vagus nerve. The aneurysm and vagus nerve were carefully dissected using a low-power bipolar (20 Malis; 3 watts), leaving connective tissue on the vagus nerve side. The aneurysm was detached from the vagus nerve without injury. Based on intraoperative findings, one patient underwent clipping, and the other underwent aneurysmectomy and primary closure for aneurysm obliteration and angioplasty. Both patients were discharged without any cranial nerve dysfunction. The selection of a strategy based on intraoperative findings and low-power bipolar cutting is important for the treatment of extracranial carotid artery aneurysms to preserve cranial nerves.

Phase-contrast magnetic resonance imaging of intracranial and extracranial blood flow in carotid near-occlusion

PurposeCompare extracranial internal carotid artery flow rates and intracranial collateral use between conventional ≥ 50% carotid stenosis and carotid near-occlusion, and between symptomatic and asymptomatic carotid near-occlusion.MethodsWe included patients with ≥ 50% carotid stenosis. Degree of stenosis was diagnosed on CTA. Mean blood flow rates were assessed with four-dimensional phase-contrast MRI.ResultsWe included 110 patients of which 83% were symptomatic, and 38% had near-occlusion. Near-occlusions had lower mean internal carotid artery flow (70 ml/min) than conventional ≥ 50% stenoses (203 ml/min, P < .001). Definite use of ≥ 1 collateral was found in 83% (35/42) of near-occlusions and 10% (7/68) of conventional stenoses (P < .001). However, there were no differences in total cerebral blood flow (514 ml/min vs. 519 ml/min, P = .78) or ipsilateral hemispheric blood flow (234 vs. 227 ml/min, P = .52), between near-occlusions and conventional ≥ 50% stenoses, based on phase-contrast MRI flow rates. There were no differences in total cerebral or hemispheric blood flow, or collateral use, between symptomatic and asymptomatic near-occlusions.ConclusionNear-occlusions have lower internal carotid artery flow rates and more collateral use, but similar total cerebral blood flow and hemispheric blood flow, compared to conventional ≥ 50% carotid stenosis.

Neurological Improvement by One-Thirds Is Associated With Early Recanalization in Stroke With Large Vessel Occlusion.

A proportion of large vessel occlusion strokes demonstrate early recanalization, obviating the initial intention to proceed to endovascular thrombectomy. Neurological improvement is a possible surrogate marker for reperfusion. We aimed to determine the optimal threshold of neurological improvement, as defined by the National Institutes of Health Stroke Scale (NIHSS), which best associates with early recanalization. We retrospectively analyzed consecutive patients with large vessel occlusion transferred from primary stroke centers to a tertiary comprehensive stroke center in Melbourne, Australia, for possible endovascular thrombectomy from January 2018 to December 2022. Absolute and percentage changes in NIHSS between transfer, as well as other definitions of neurological improvement, were compared using receiver operating characteristic curve analysis for association with recanalization as defined by the absence of occlusion in the internal carotid artery, middle cerebral artery (M1 or M2 segments), or basilar artery on repeat vascular imaging. Six hundred and fifty-four transferred patients with large vessel occlusion were included in the analysis: mean age was 68.8±14.0 years, 301 (46.0%) were women, and 338 (52%) received intravenous thrombolytics. The proportion of extracranial internal carotid artery, intracranial internal carotid artery, M1, proximal M2, and basilar artery occlusion was 18.8%, 13.6%, 48.3%, 15.0%, and 4.3%, respectively, on initial computed tomography angiogram. Median NIHSSprimary stroke center and NIHSScomprehensive stroke center scores were 15 (interquartile range, 9-18) and 13 (interquartile range, 8-19), respectively. Early recanalization occurred in 82 (13%) patients. NIHSS reduction of ≥33% was the best tradeoff between sensitivity (64%) and specificity (83%) for identifying recanalization. NIHSS reduction of ≥33% had the highest discriminative ability to predict recanalization (area under the curve, 0.735) in comparison with other definitions of neurological improvement. One-third neurological improvement between the primary hospital and tertiary center was the best predictor of early recanalization.

Drug-Coated Balloons for Treatment of Internal Carotid Artery Restenosis After Stenting: A Single-Center Mid-Term Outcome Study

PurposeEndovascular and surgical treatments of stenosis of the extracranial internal carotid artery (ICA) are common procedures, yet both introduce a risk of restenosis due to endothelial hyperplasia. Drug-coated balloons (DCBs) are designed to decrease neointimal hyperplasia, however rarely used in the neurovascular setting. This study retrospectively analyzes mid-term results of DCB-treated in-stent restenosis (ISR) of the ICA.Materials and MethodsThe medical history, comorbidities, and periprocedural data of patients receiving DCB treatment for > 50% ISR of the ICA after carotid artery stenting were analyzed. Follow-up after DCB treatment was performed with Doppler ultrasound. Suspicious cases were checked with CT- or MR-angiography and—if there was agreement between the modalities—validated with digital subtraction angiography. Potential risk factors for restenosis and differences in outcomes after PTA with three types of DCB balloons were evaluated.ResultsDCB treatment was performed in 109 cases, 0.9% of which involved in-hospital major stroke; no minor strokes occurred. A total of 17 patients (15.6%) had recurrent ISR after DCB treatment, after a mean time of 30.2 months (7–85 months). Tobacco use was significantly associated with a higher incidence of recurrent ISR.ConclusionDCB angioplasty for ISR is an effective treatment that may delay and decrease restenosis. Treating comorbidities and adopting lifestyle changes may additionally help prevent ISR.Graphical

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P= 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P= 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P= 0.001). In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

Abstract TP142: Perfusion Profiles to Identify Acute Extracranial Internal Carotid Artery Atherosclerosis-Related Stroke Prior to Endovascular Therapy

Introduction: Perfusion imaging has been used to assess collateral status in patients with acute ischemic stroke secondary to anterior large-vessel occlusion. We aimed to evaluate the hypoperfusion intensity ratio (HIR), a surrogate of collateral status, in acute stroke secondary to extracranial atherosclerosis disease (AD) compared with extracranial non-AD etiologies prior to EVT. Methods: We retrospectively reviewed the data of consecutive EVT stroke patients in our prospectively collected registry from January 2019 to December 2022. Inclusion criteria: patients with anterior circulation stroke with concomitant extracranial internal carotid artery (ICA) disease with 70-100% stenosis per NASCET criteria and patients who underwent computed tomography perfusion (CTP) before EVT. Patients were divided into those with extracranial AD and non-AD based on clinical and radiological characteristics. HIR was calculated as the volume of ischemic brain tissue with a Tmax&gt;10s divided by a Tmax&gt;6s. A relative CBF&lt;30% was also obtained. Multivariable regression was used to identify the HIR independently associated with extracranial ICA AD-related stroke; adjusted odds ratio with 95%CIs were calculated using the non-AD group as a reference. Results: Among all 624 EVT patients, 79 met inclusion criteria. Of these patients (21 women [36.2%]; median age 67 [60-75] years), 58 (72.5%) had extracranial ICA AD. Patients in the AD group had significantly lower CBF&lt;30% (median 8ml [0-17] vs 19ml [9-36]), lower Tmax&gt;10s (median 29ml [11-69] vs 68ml [38-117]), and lower HIR (median 0.27 [0.13-0.45] vs 0.49 [0.42-0.59]). There was no significant difference in time from last know well to CTP between groups. Lower HIR was independently associated with AD after adjusting for variables related to AD (Figure1). Conclusions: Low HIR values was a predictor of stroke secondary to extracranial ICA AD and could be helpful to differentiate from other non-AD etiologies prior to EVT.

Abstract WP194: Quantified Effects of Intra-Arterial Vasodilatory Therapy for Cerebral Vasospasm

Introduction: Cerebral vasospasm is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Though used routinely in clinical practice, objective metrics to evaluate effectiveness of intra-arterial vasodilatory treatment (IAT) have not been identified. To quantify effects of IAT on flow dynamics in cerebral vasospasm, we retrospectively compared Lindegaard ratios (LR) of aSAH patients pre-and post-IAT. Methods: Subjects included 24 aSAH patients undergoing IAT in the bilateral middle cerebral arteries (MCA) for cerebral vasospasm, diagnosed by standard clinical and radiographic criteria. Subjects were excluded if balloon angioplasty was performed prior to/within 2 days of the index procedure. All subjects received 10 mg IA milrinone, a non-catecholamine phosphodiesterase inhibitor drug, per MCA. Transcranial doppler (TCD) ultrasound was measured pre-IAT (D0) and at D+1 and D+2 post-IAT. LR was calculated as the ratio of mean flow velocities in the middle cerebral artery (MCA) to the ipsilateral extracranial internal carotid artery. Standard threshold for vasospasm is defined as LR&gt;3. Results: Right and left LR were aggregated, total N=48. Average pre-IAT LR was 2.96 (R 2.67/L 3.25±1.29). Post-IA LR were 2.72±1.12 and 3.15±1.55 at D+1 and D+2, respectively. Subjects with pre-IA LR&gt;3 showed an average LR decrease of 21% post-IAT D+1 (p=0.01) and an 8% decrease at D+2 (p=0.16) [Fig.1A]. Subjects with pre-IAT&lt;3 experienced an average LR increase of 28% by D+2 (p=0.02) [Fig 1B]. Conclusion: Subjects with TCD confirmed vasospasm (LR&gt;3) at D0 showed a significant improvement in cerebral blood flow one day after therapy. Subjects who did not meet TCD threshold for vasospasm (LR&lt;3) showed little change one day post-IAT but worsening cerebral blood flow by day two post-IAT. Further study is needed to determine whether LR can be used to predict benefit or objectively assess effectiveness of IAT in aSAH patients with cerebral vasospasm.

Abstract WP187: Association of Renin Angiotensin Aldosterone Blockade and Hypotension After Carotid Artery Stenting

Background: Persistent hypotension after carotid artery stenting (CAS) can lead to adverse outcomes, prolong length of stay (LOS), and increase hospital costs. As catecholamine plays a critical role in blood pressure (BP) regulation, we aimed to determine the relationship between the use of renin-angiotensin-aldosterone inhibitor (RASI) drugs and post-CAS hypotension. Methods: A multicenter prospective study of patients with extracranial internal carotid artery stenosis and history of hypertension requiring CAS at two hospitals in China between January 2020 to May 2023. BP was recorded at frequent intervals for at least 24 hours post-CAS. Blood catecholamine concentrations were assessed in the morning of, and day immediately after, CAS in a subset of patients. Persistent hypotension was defined as systolic BP &lt;90 mmHg or requiring vasopressor treatment for at least 6 hours. Logistic regression models assessed differences in the rates of post-CAS hypotension between RASI and non-RASI patients with adjustment for known confounding variables. Findings: There were 329 patients included: 160 in the RASI group and 169 in the non-RASI group. The RASI group had a higher rate of persistent hypotension (relative risk 1.52, P=0.031). The RASI group showed a greater decline in norepinephrine concentration after CAS compared with the non-RASI group (P=0.008). Patients with persistent post-CAS hypotension showed a similar decline in norepinephrine concentration (P=0.004) when compared with patients without persistent hypotension. Persistent hypotension prolonged LOS (P=0.014). Conclusion: Prior use of RASI for the treatment of hypertension is associated with persistent hypotension after CAS. A relation between decline of norepinephrine after stenting and persistent hypotension supports the role of catecholamine in BP control.

Extracranial Internal Carotid Artery Fenestration: A Case Report

Extracranial Internal Carotid Artery Fenestration: A Case Report

Recurrent Bilateral Extracranial Internal Carotid Artery Stenosis.

Recurrent Bilateral Extracranial Internal Carotid Artery Stenosis.

Recurrence of an extracranial internal carotid artery aneurysm treated with STA-MCA bypass and trapping due to neovascularization from an ascending pharyngeal artery: illustrative case.

Extracranial internal carotid artery aneurysms (EICAs) are rare. Although a high mortality risk has been reported in nonoperated cases, the optimal treatment for EICAs remains unknown. A 79-year-old female presented with painless swelling in the right neck. Imaging revealed a giant EICA with a maximum diameter of 3.2 cm. Superficial temporal artery-middle cerebral artery bypass and internal carotid artery (ICA) trapping were performed. Because the distal aneurysm edge was at the C1 level, the distal portion of the aneurysm was occluded by endovascular coiling, and the proximal portion was surgically ligated. Blood flow into the aneurysm disappeared after the operation. Three years postsurgery, enlargement of the aneurysm with blood flow from the ascending pharyngeal artery (APA) was detected. The EICA was resected after coiling the APA and ligating both ends of the aneurysm. Pathologically, neovascularization within the aneurysm wall was observed. Even if blood flow into an EICA disappears after ICA trapping, the EICAs can enlarge due to neovascularization from the neighboring artery. From the outset, removal of the aneurysm should be considered as a radical treatment strategy for giant EICAs.

Analysis of the correlations between the extracranial internal carotid artery and extracranial vertebral artery and mild cognitive impairment.

Vascular tortuosity is a prevalent morphological change that frequently occurs in arteries across different parts of the body. To analyze the relationship between the tortuosities of the extracranial internal carotid artery (EICA) and extracranial vertebral artery (EVA) with mild cognitive impairment. The tortuosity index (TI), vascular deviation degree, tortuosity degree, and angle number of the EICA and EVA were retrospectively analyzed and calculated in 160 patients who underwent computed tomography angiography (CTA) in this study's department, and the Montreal cognitive assessment was adopted to evaluate the cognitive function of the patients. The differences in age, gender, arterial hypertension (AH), and diabetes mellitus (DM) between the normal group and the mild cognitive impairment group were statistically significant (p< 0.01). The TI was negatively correlated with the score of cognitive function. The tortuosities of the EICA and EVA were correlated with mild cognitive impairment (p< 0.05). The reduction in visual-spatial ability was correlated with the right EICA tortuosity, and the reduction in memory was correlated with the EVA tortuosity. Age, gender, HP, DM, and coronary heart disease (CHD) were potential risk factors for carotid tortuosity (p< 0.05). There was a significant correlation observed between the TIs of both the EICA and EVA and the presence of mild cognitive impairment. Advanced age, female, HP, DM, and CHD were independent risk factors for EICA and EVA tortuosities.

Relationship between the Tortuosity of the Extracranial Internal Carotid and Vertebral Arteries on Magnetic Resonance Imaging/Angiography and Vascular Risk Factors in a Japanese Population.

Objective We aimed to investigate the relationship between tortuosity of the extracranial internal carotid artery (ICA) or vertebral artery (VA) and vascular risk factors among residents of Asahikawa, northeast Japan. Methods We retrospectively surveyed participants of "brain dock" medical brain checkups, which involved magnetic resonance imaging and angiography. We measured the tortuosity of the ICA and VA, and evaluated vascular risk factors based on medical interviews, questionnaires, and medical records. Results A total of 218 participants were enrolled in the study. ICA tortuosity (right and left) was significantly correlated with age [odds ratio (OR): 2.452, 95% confidence interval (CI): 1.695-3.548, p<0.001]. A more pronounced correlation was observed in females than in males (OR: 1.678, 95% CI: 1.004-2.807, p=0.048). VA tortuosity (right and left) was significantly correlated with age (OR: 1.786, 95% CI: 1.250-2.550, p=0.001) and smoking history (OR: 2.140, 95% CI: 1.235-3.707, p=0.007), and was more pronounced in females than in males (OR: 1.864, 95% CI: 1.107-3.137, p=0.019). Conclusion ICA tortuosity was correlated with age, while VA tortuosity was correlated with age and smoking history. ICA and VA tortuosity were more pronounced in females than in males.

Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source

Abstract Purpose Non-stenotic (&lt; 50%) carotid disease may play an important etiological role in ischemic stroke classified as embolic stroke of undetermined source (ESUS). We aimed to assess the prevalence of non-stenotic carotid disease and its association with ipsilateral ischemic stroke. Methods Data are from ESCAPE-NA1, a randomized controlled trial investigating the neuroprotectant nerinetide in patients with acute ischemic stroke and large vessel occlusion (LVO). The degree of stenosis of the extracranial internal carotid artery (ICA) and high-risk plaque features were assessed on baseline computed tomography (CT) angiography. We evaluated the association of non-stenotic carotid disease and ipsilateral stroke by age-adjusted and sex-adjusted logistic regression and calculated the attributable risk of ipsilateral stroke caused by non-stenotic carotid disease. Results After excluding patients with non-assessable imaging, symptomatic &gt; 50% carotid stenosis and extracranial dissection, 799/1105 (72.1%) patients enrolled in ESCAPE-NA1 remained for this analysis. Of these, 127 (15.9%) were classified as ESUS. Non-stenotic carotid disease occurred in 34/127 ESUS patients (26.8%) and was associated with the presence of ipsilateral ischemic stroke (odds ratio, OR 1.6, 95% confidence interval, CI 1.0–2.6, p = 0.049). The risk of ipsilateral ischemic stroke attributable to non-stenotic carotid disease in ESUS was estimated to be 19.7% (95% CI −5.7% to 39%), the population attributable risk was calculated as 4.3%. Imaging features such as plaque thickness, plaque irregularity or plaque ulceration were not different between non-stenotic carotids with vs. without ipsilateral stroke. Conclusion Non-stenotic carotid disease frequently occurs in patients classified as ESUS and is associated with ipsilateral ischemic stroke. Our findings support the role of non-stenotic carotid disease as stroke etiology in ESUS, but further prospective research is needed to prove a causal relationship.

Risk factors for peri-procedural stroke or death in internal carotid artery stenting: A neurology team experience

Background and Objectives: Suitable cases of extracranial internal carotid artery (ICA) stenosis can be treated with carotid artery stenting (CAS) or carotid endarterectomy. However, major complications in the peri-procedural period, like stroke and death, are more common with CAS. We therefore investigated the risk factors for stroke and death during the peri-procedural period following CAS. Methods: In this study, the files of patients who were treated with CAS by a neurology team during 2020–2022 were retrospectively analyzed. Patient age, gender, vascular risk factors, use of antiplatelet therapy, type of carotid artery stenosis (symptomatic or asymptomatic), measured stenosis degrees, contralateral carotid stenosis, types of aortic arch, balloon angioplasty, use of a filter-type embolism protection device, stent cell design (open or closed), and peri-procedural death, stroke, or myocardial infarction (MI) were recorded. All patients were followed up for the first 30 days after CAS. Results: The mean age of 219 patients included in our study was 67.8 ± 8.38 years and 68.5% were male. The most common comorbid diseases in the patients were hypertension (76.7%), hyperlipidemia (53.4%) and diabetes mellitus (DM) (43.4%). Stroke or death occurred in the peri-procedural period in 15 (6.85%) of the patients, but MI did not occur. No statistically significant difference was observed in terms of age or gender when comparing with the cases without stroke or death. Of the patients suffering stroke or death, ischemic stroke developed in 13 (86.67%), cerebral hemorrhage in two (13.33%) and two patients (13.33%) died. Two-thirds of the strokes were either minor (n=7, 46.67%) or moderate (n=4, 26.67%); 13 (86.67%) were ipsilateral, and 14 (93.33%) were in the anterior circulation. The complication risk was found to be significantly higher in patients with prior stroke (OR=3.865; 95% CI 1.282 to 11.652 p=.016), DM (OR=3.634; 95% CI 1.102 to 11.992 p=.034) and pre-dilation angioplasty (OR=13.100; 95% CI 1.762 to 97.422 p=.012). Conclusion: Prior stroke, DM and pre-dilation angioplasty increase peri-procedural stroke and death in CAS. However, even if a stroke complication develops after CAS, it is often not severe.

Intravascular Treatment of Extracranial Internal Carotid Artery Dissection

Objective: To evaluate the efficacy and safety of endovascular treatment of extracranial dissection of the internal carotid artery, as well as pseudoaneurysm associated with dissection.Clinical cases: In this article we report the results of endovascular treatment of 2 patients with iatrogenic and spontaneous dissection of the cervical segment of the internal carotid artery.Conclusions: Internal carotid artery dissection can lead to significant narrowing of the vessel lumen, occlusion or pseudoaneurysm followed by hemodynamic or embolic stroke despite anticoagulant therapy. In some cases, endovascular stenting for dissection is a safe and effective method of restoring vessel lumen integrity with a good clinical outcome.