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  • Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke

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Innovations in treatment
Case report
Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke
  1. Laura Ludovica Gramegna1,2,
  2. Analía Cardozo3,
  3. Edgar Folleco4 and
  4. Alejandro Tomasello3
  1. 1 IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
  2. 2 Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
  3. 3 Department of Radiology, Interventional Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain
  4. 4 Department of Radiology, Fundación Clínica Valle del Lili, Cali, Valle del Cauca, Colombia
  1. Correspondence to Dr Laura Ludovica Gramegna; lauraludovica.gramegna{at}unibo.it

Abstract

Intracranial carotid artery dissections are challenging, as there are no specific guidelines for their treatment, and most research suggests solutions for treating those involving extracranial vessels. We describe a patient with an acute ischaemic stroke within the territory of the right internal carotid artery, who was found to have intracranial carotid artery dissection during the thrombectomy procedure. The dissected lumen was successfully reconstructed via deployment of a Derivo flow-diverter stent. A balloon-assisted ‘jacking’ manoeuvre, in which a balloon is partially inflated at the beginning of the dissection to serve as leverage, was used to overcome the challenge of navigating the microcatheter tip through the stenosis proximal to the dissection. This case demonstrates the feasibly and safety of stenting with a flow diverter in a patient with internal carotid artery dissection; however, further studies are needed to confirm this finding.

  • interventional radiology
  • vascular surgery
  • stroke

https://doi.org/10.1136/bcr-2019-231612

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    Footnotes

    • Contributors LLG contributed to conception and design, acquisition of data or analysis and interpretation of data, drafted the article or revised it critically for important intellectual content. AC contributed to acquisition of data or analysis and interpretation of data, drafted the article or revised it critically for important intellectual content. EF contributed to acquisition of data or analysis and interpretation of data, drafted the article or revised it critically for important intellectual content. AT contributed to conception and design, acquisition of data or analysis and interpretation of data, drafted the article or revised it critically for important intellectual content. All authors approved the version published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.