Abstract 250: Early Revascularization in Cervical Artery Dissection: Case Studies of Improved Neurological Outcomes

Introduction Cervical artery dissection (CAD) involves a tear in the inner lining of the carotid or vertebral artery, contributing to up to 25% of ischemic strokes in individuals under 50 years of age. This condition can lead to the formation of a false lumen within the vessel wall, potentially causing intraluminal thrombus, vessel stenosis, or pseudoaneurysm, ultimately leading to cerebral ischemia. Endovascular therapy is an option for recurrent cerebrovascular events, dissecting aneurysms, and severe stenosis, as well as in cases where anticoagulation is not tolerated. Here, we describe two cases of left internal carotid artery dissections that required revascularization due to recurrent episodes of reduced blood supply or distal embolism. Methods Electronical medical records review. Results Case 1: A 39‐year‐old man with a history of hypertension, hyperlipidemia, and migraine presented with traumatic bilateral carotid stenosis due to dissection after a fall. Initially discharged on antiplatelet agents and returned with TIA symptoms of left hemispheric hypoperfusion followed by a small left MCA stroke. Catheter angiography revealed cervical ICA dissection with a false and true lumen, along with a 99% distal cervical carotid stenosis and trace distal flow. Revascularization was performed by crossing the stenosis with an Aristotle 14 wire for good distal access. Subsequently, the Spider device was deployed in the petrous internal carotid, and Xact stents (8times6x40mm and 9times7x40mm) were placed across the distal and proximal portion of the stenosis. Post‐intervention, the patient was started on Eptifibatide infusion for 4 hours, followed by DAPT and Apixaban upon discharge. At the 30‐day follow‐up, the patient had a modified Rankin Scale (mRS) score of 0 and repeated carotid Doppler ultrasonography (CDUS) showed a patent stent. Case 2 A 36‐year‐old female with a history of hyperlipidemia, depression, and hypertension presented as a level 1 code stroke for aphasia and right hemiplegia. On arrival, her NIHSS was 9. CTA head and neck revealed a left ICA occlusion caused by dissection with reconstitution and occlusion of the left MCA inferior division. Catheter angiography revealed a left ICA occlusion due to dissection with a true and false lumen and distal reconstitution of the vessel. The diagnostic catheter and base catheter were advanced past the dissection, and a thrombectomy was performed using an Aristotle 14 wire catheter with aspiration and a stent retriever with TICI 2b reperfusion. Following this, the catheter was retracted to the cervical carotid, and the Walrus balloon was inflated, followed by the deployment of Xact stents (8times6x40mm and 9times7x40mm). Post‐intervention, the patient was started on Aspirin and Ticagrelor. Subsequent MRI of the brain and MRA showed a left MCA stroke with occlusion of the stent, which CDUS confirmed. Despite this, on discharge, the patient had mixed aphasia and RSW (3/5 strength). At 30 days, the patient had mild expressive aphasia with a mRS of 2, which improved to a mRS of 1 at 90 days. Conclusion These cases illustrate examples of select situations where early revascularization intervention can improve neurological outcomes under specific conditions. Additional studies are required.