• Dong Joon Kim, Byung Moon Kim, Sang Hyun Suh, and Dong Ik Kim.
• *Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; ‡Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea.
• Neurosurgery. 2015 Feb 1;76(2):158-64; discussion 164.

BackgroundThe prognosis of ischemic anterior circulation intracranial dissection (AC-ICD) is poor and its optimal management is still controversial.ObjectiveTo evaluate the safety and efficacy of a self-expanding stent for ischemic AC-ICD.MethodsEight patients (mean age, 36 years) underwent self-expanding stenting for ischemic AC-ICD. Imaging findings of ischemic AC-ICD, the reason for stenting, and the clinical and angiographic outcomes were retrospectively evaluated.ResultsAC-ICD involved intracranial internal carotid artery to middle cerebral artery (MCA) in 2, intracranial internal carotid artery alone in 3, and MCA alone in 3 patients. Six AC-ICDs showed complete or near occlusions while 2 had a severe degree of stenosis. Six AC-ICDs showed an intimal flap and 3 had intramural hematomas. Six patients underwent emergent stenting for acute stroke within 6 hours (n=2) or crescendo-type stroke within 24 hours (n=4), while 2 patients had stenting for recurrent ischemia on dual antiplatelet and/or anticoagulation after the initial attack. The mean dissection-related stenosis improved from 93.1% to 20.3% after stenting (P<.05). The mean National Institutes of Health Stroke Scale score improved from 7.5 to 1.4 (P<.05). All patients had excellent or favorable outcomes at 3 months: modified Rankin Scale score, 0 in 3, 1 in 3, and 2 in 1 patient(s). No patients had subarachnoid hemorrhage or ischemic symptom recurrence during the clinical follow-up (mean, 27 months). All stented arteries were patent without significant in-stent stenosis on angiographic follow-up (range, 3-12 months).ConclusionSelf-expanding stents seem to be safe and effective for AC-ICD presenting with acute/crescendo-type stroke or recurrent ischemia despite adequate medication.

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