Parallel guidewire technique in acute ischemic stroke secondary to carotid artery dissection

Abstract

Background: The aim of the study was to evaluate the influence of endovascular therapy (EVT) on the acute ischemic stroke (AIS) secondary to carotid artery dissection (CAD). Methods: This single-center retrospective study enrolled 17 patients admitted with AIS secondary to CAD from January 2018 to November 2019 in the Department of Neurology, Shenzhen Hospital of Southern Medical University where patients received EVT with guidewire or parallel guidewire. Outcomes including postoperative complications were recorded, the prognostic factors of patients were explored, and the effectiveness of single guidewire versus parallel guidewire on EVT was compared. Results: Before treatment, the mean National Institute of Health stroke scale (NIHSS) was 14.4 in 10 cases (58.8%) of CAD complicated with intracranial artery embolism. All patients underwent EVT, and the success rate of operation was 100%. After all interventions, modified thrombolysis in cerebral ischemia (mTICI) 3 reperfusion was achieved in 14 patients (82.4%), and mTICI 2b reperfusion was achieved in 3 (17.6%). One patient had cerebral infarction and edema complicated with cerebral hernia, one patient had cerebral hemorrhage, one patient had complicated subarachnoid hemorrhage, and five cases had asymptomatic cerebral hemorrhage. Three months after treatment, 14 cases (82.3%) achieved a good clinical outcome (modified Rankin scale, mRS: 0–2). Puncture-to-reperfusion time in the parallel guidewire group was significantly shorter than that of the single guidewire group. However, the differences in NIHSS score, postoperative mTICI, and mRS score between both groups did not reach significance. Conclusions: CAD patients receiving EVT have a good prognosis, and application of a parallel guidewire can reduce operation time.