Endovascular management and outcome of acute middle cerebral artery stroke in the setting of spontaneous carotid dissection (P1.012)

Objective: Endovascular Management and Outcome of Acute Middle Cerebral Artery (MCA) Stroke in the Setting of Spontaneous Carotid Artery Dissection (CAD) Backround: CAD poses a challenge in the management of acute large vessel occlusive disease. Dissection decreases the chances of revascularization with the IV tpa and could potentially lead to unsatisfactory endovascular results if improperly treated. We describe our experience in endovascular management of acute stroke in the setting of CAD. Methods: A retrospective review of a prospectively maintained database at our center of acute strokes undergoing IA therapy between March 2012 and June 2014 was performed. Thirteen consecutive acute MCA strokes with CAD underwent endovascular therapy. 69[percnt] (9/13) dissections were located at the skull base. 360 degree loop was present in the distal cervical ICA in 46[percnt] (6/13) cases. Carotid artery occlusion was noticed in 33[percnt] (5/13) cases and three of these lesion required stent placement. Most of the non-occlusive dissection lesions retained good flow after revascularization of the MCA was performed due to the passage of a large bore catheter. 50[percnt] of both stenting and non-stenting patients achieved mRS 0-1 at 3 months. 2/12 (17[percnt]) died and both had non-occlusive dissection with no stent placement. Results: Carotid dissection is common in tortuous vessels mainly at skull base. Carotid artery occlusion is more likely to require stent placement to maintain adequate distal perfusion. Good functional outcome (mRS<2) depends on adequate revascularization and seems to be independent of stenting vs non-stenting. Conclusion: This study provides additional evidence that endovascular management of carotid artery dissection in acute middle cerebral artery is effective and safe to maintain distal revascularization. Revascularization can be achieved with a combination of stenting, large catheter mediated angioplasty and thrombectomy. Further studies are warranted to investigate the role of endovascular recanalization for this stroke subtype Disclosure: Dr. Gulati has nothing to disclose. Dr. Aghaebrahim has nothing to disclose. Dr. Ducruet has nothing to disclose. Dr. Jankowitz has nothing to disclose. Dr. Jovin has received personal compensation for activities with Covidein, Concentric Medical Inc., Stryker, and Silk Road Medical. Dr. Jadhav has nothing to disclose.