Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan...

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Reconstruction of Tortuous Cervical Internal Carotid Artery Dissection with Pipeline Stent Ahsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College of Wisconsin

Transcript of Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan...

Page 1: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Reconstruction of Tortuous Cervical Internal Carotid Artery Dissection

with Pipeline Stent

Ahsan Sattar, MD, and Brian-Fred Fitzsimmons, MD

Neurointerventional Fellow

Medical College of Wisconsin

Page 2: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Case

• 73-year-old Caucasian male presented with acute right middle cerebral artery (MCA) stroke symptoms.

• NIHSS 2 • IV tPA • NICU admission overnight • Over the next 24-36 hours he started to decline

neurologically with worsening left sided weakness.

• Day 2 NIHSS 11

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CTA Neck

Page 4: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Cervical ICA AP and Lateral

Page 5: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

PED Deployment

Page 6: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Second PED Deployment

Page 7: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Cervical ICA AP and Lateral

Page 8: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Cerebral Angiogram Post PED Deployment

Page 9: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Post Thrombectomy Cerebral Angiogram

Page 10: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Post Thrombectomy

Page 11: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Eighteen months follow up

Page 12: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Conclusion

• Endovascular stent reconstruction of very tortuous cervical internal carotid artery (ICA) dissections remains a challenging procedure.

• The presence of a 360-degree loop in the ICA makes the use of traditional carotid stents arduous.

• The use of the Pipeline embolization device (PED), which is primarily approved for wide neck intracranial aneurysms, could be an alternative stent for use in such ICA dissection treatment.

Nelson, P. K., Lylyk, P., Szikora, I., Wetzel, S. G., Wanke, I., & Fiorella, D. (2011). The pipeline embolization device for the intracranial treatment of aneurysms trial. American Journal of Neuroradiology, 32(1), 34–40. doi:10.3174/ajnr.A2421

Page 13: Successful Endovascular Reconstruction of Tortuous ...svin.org/files/Sattar_pipeline.pdfAhsan Sattar, MD, and Brian-Fred Fitzsimmons, MD Neurointerventional Fellow Medical College

Thanks


Jess Hwang, MD Endocrinology fellow 5/8/14wordpress.uchospitals.edu/endopublic/files/downloads/2014/05/2014...Neurointerventional radiology service saw her and ... Patton JS, Brain

Jess Hwang, MD Endocrinology fellow 5/8/14wordpress.uchospitals.edu/endopublic/files/downloads/2014/05/2014...Neurointerventional radiology service saw her and ... Patton JS, Brain

Alison McInturff, MD 232-1443...David Denton, MD Matthew Murdoch, MD Brian Fulks, MD Gentry Yost, MD Shaun Summerill, MD Laura Duty, MD Elizabeth Parsons, MD Matthew Stelzer, MD David

Alison McInturff, MD 232-1443...David Denton, MD Matthew Murdoch, MD Brian Fulks, MD Gentry Yost, MD Shaun Summerill, MD Laura Duty, MD Elizabeth Parsons, MD Matthew Stelzer, MD David

D.Bruni, MD; L.Bragonzoni, PhD; M.Gagliardi, MD; M.Bontempi, PhD; Akkawi I, MD; G.Raspugli,MD, Tedi M, MD; S.Patella, MD; Prof. M.Marcacci, MD. Rizzoli.

D.Bruni, MD; L.Bragonzoni, PhD; M.Gagliardi, MD; M.Bontempi, PhD; Akkawi I, MD; G.Raspugli,MD, Tedi M, MD; S.Patella, MD; Prof. M.Marcacci, MD. Rizzoli.

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What Have We Learned: Selection for Endovascular Stroke ...svin.org/files/Nogueira_Learned.pdf · Raul G Nogueira, MD Associate Professor in Neurology, Neurosurgery, and Radiology

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PHYSICIAN CHAIRMENPatrick McCarville, MD Joseph McCaslin, MD Lindsay Northam, MD Charles Olson, MD John Park, MD Jim Reilly, MD William Shiffermiller, MD Charles Ternent, MD Mark Wilson,

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Overview of available flow diverters - svin.org

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Motor neuroprosthesis implanted with neurointerventional ......2020/10/23  · (ITU, Synchron, CA, USA) (online supplemental figure S1). Vascular electrocorticographic signal (0.125

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Neurointerventional Fellowship Programs - snisonline.org Fellowship... · Neurointerventional Fellowship Programs For More Information Contact: ... Thanh Nguyen Contact Person: ...

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Editorial Board...HUMPHREY, MD JASON EMER, MD ADAM SCHAFFNER, MD HENRY SPINELLI, MD GRANT STEVENS, MD ANDREW JACONO, MD MICHAEL KAMINER, MD Editorial …

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