Endovascular flow diversion reconstruction of petrocervical dissections with the proximal anchoring technique: Experience in 31 consecutive cases.

Abstract

Introduction: Flow diverting stents (FDS) are routinely used to reconstruct the arteries of the head and neck. When placed into the mobile cervical internal carotid artery (cICA) segment, the FDS runs the risk of post-procedure stent migration and proximal intimal hyperplasia reaction from physiologic movement of the neck. We report our experience using a novel proximal anchoring technique during endovascular flow reconstruction of complex petrocervical dissections to prevent this potentially deleterious result.

Methods: We reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify cases of FDS treatment in the mobile petrocervical segments which had the proximal FDS "anchored" with a nitinol stent.

Results: The proximal anchoring technique was successfully performed in the mobile cervical segment in a total of 31 cases over the study period. Each case involved a complex ICA dissection with 68% (n = 21) having an accompanying pseudoaneurysm. Fifty-two percent (n = 16) were female. Surpass Streamline and Evolve FDS were utilized in all cases. An average of 2.2 ± 0.1 FDS devices were utilized (range 2-4 FDS), with each case utilizing a laser-cut nitinol carotid stent as the proximal anchor. The average stent diameter was 5.64 ± 0.2 mm (range 4-8 mm) and length of 30.1 ± 1.5 mm (range 20-60 mm). On last follow-up angiography, there were no instances of stent migration or proximal neointimal hyperplasia.

Conclusion: Utilization of the proximal anchoring technique on FDS constructs in the mobile cICA may provide additional protection from post-procedure stent migration and intimal reaction attributed to patient neck movement resulting in augmentation of successful healing.