Mid-term outcomes of endovascular treatment for internal carotid artery dissection.

Background: This study aims to assess the feasibility and safety of endovascular treatment of spontaneous internal carotid artery dissections (ICAD) using a proximal embolic protection device (EPD).

Methods: From January 2012 to December 2023 all consecutive patients admitted for ICAD who underwent carotid artery stenting using MoMa Ultra (Medtronic, Minneapolis, MN, USA) proximal EPD were included in this single-center study and were retrospectively analyzed. The presence of neurological symptoms was the only indication for treatment. Early outcomes included technical success, perioperative mortality, and major cardiovascular and cerebral complications. Late outcomes were recurrent neurological symptoms, patency, and reinterventions.

Results: A total of 9 patients were included in the study, all presenting with neurological symptoms. Among them, 8 were diagnosed with a transitory ischemic attack (TIA), while 1 had amaurosis fugax and transitory aphasia. Significant haemodinamic ICAD were 7. Complete anatomic resolution was achieved in all patients with no further lesions of the carotid axis. At a median follow-up of 63.9 months (IQR 27.1- 63.3), a single patient died due to worsening of pre-existent chronic heart failure; no intrastent restenosis were registered and all stents were patent.

Conclusions: The use of a proximal EPD for endovascular treatment of ICAD under flow arrest seems to be feasible and safe, minimizing the risk of intraoperative stroke. Larger series are required to confirm these results and validate the treatment strategy.