Long-term clinical and angiographic outcomes in patients with cervico-cranial dissections treated with stent placement: a meta-analysis of case series

J Neurotrauma. 2012 May 1;29(7):1342-53. doi: 10.1089/neu.2011.1963. Epub 2012 Feb 7.


Limited clinical and angiographic data exists for patients with spontaneous or traumatic cervico-cranial dissections treated with stent placement. We reviewed clinical and angiographic data on consecutive patients admitted to our hospital with spontaneous, traumatic, and iatrogenic cervico-cranial dissections treated with stent placement to study immediate and long-term clinical and angiographic outcomes. Additional patients were identified using pertinent studies published between 1980 and 2009, using a search of the PubMed, Cochrane, and Ovid libraries. Post-procedure complications and clinical outcomes were documented. Angiographic abnormalities collected at follow-up included presence of in-stent restenosis or pseudoaneurysm. After applying our strict search criteria, four studies including our series were used in the meta-analysis, representing 46 patients (mean age [standard deviation] 47 ± 14 years; 24 [52%] male) treated with stent placement for dissection. Overall, 72 stents were placed to treat 28 spontaneous, 11 traumatic, and 7 iatrogenic dissection patients with 51 dissections, involving 51 vessels; with a mean pre-stent stenosis of 71 ± 26% and mean post-stent stenosis of 6 ± 15%. The immediate and follow-up post-procedure complication rates per stent placed was 8 (11%) and 8 (11%), respectively. Among the 36 patients who underwent follow-up angiography, in-stent restenosis or pseudoaneurysms were present in 3 (8%) and 2 (6%) patients, respectively. A high rate of sustained resolution of angiographic abnormalities during long-term follow-up was noted, with a low rate of new transient ischemic attack, ischemic stroke, or death, supporting the feasibility, safety, and effectiveness of endovascular stent reconstruction.

Publication types

  • Case Reports
  • Meta-Analysis
  • Multicenter Study
  • Review

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon / instrumentation
  • Angioplasty, Balloon / mortality*
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / mortality
  • Carotid Artery, Internal, Dissection / diagnostic imaging
  • Carotid Artery, Internal, Dissection / pathology
  • Carotid Artery, Internal, Dissection / therapy*
  • Cerebrovascular Trauma / mortality
  • Cohort Studies
  • Female
  • Graft Occlusion, Vascular / mortality
  • Graft Occlusion, Vascular / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / mortality
  • Radiography
  • Retrospective Studies
  • Stents* / trends
  • Treatment Outcome
  • Vertebral Artery Dissection / diagnostic imaging
  • Vertebral Artery Dissection / pathology
  • Vertebral Artery Dissection / therapy*