Interventional Neuroradiology at Alexian Brothers Neurosciences Institute
Featured Cases
Stenting of Internal Carotid Dissection
This patient had a stroke caused by a blockage of blood supply to the left side of his brain. His symptoms of right sided weakness and speech difficulty initially improved on blood thinners but he continued to have “mini-strokes” despite best medical therapy. An angiogram was interpreted as showing a “blockage” of the left carotid artery just below the skull.
This view of a follow-up angiogram suggests that the vessel is irregular in contour and filling.
This different view from the same angiogram shows the problem much better. This patient has a carotid dissection—the wall of the carotid artery is partially torn, and blood (and x-ray dye) is accumulating under the inner lining of the vessel wall, creating a bulge called a pseudo aneurysm. The true lumen of the carotid arterys is seen to be a thread-like structure, compressed by the adjacent pseudoaneurysm.
The stent is a wire mesh tube that hold the true lumen of the artery open. It also compresses the pseudoaneurysm and will allow the vessel to heal.
Immediatley after stenting the true lume is fully opened but he pseudoaneurysm still fills.
The follow-up angiogram, unsubtracted image showing the stent.
The follow-up angiogram, subtracted image showing the carotid artery to be open with excellent flow and the pseudoaneurysm has healed. The patient has not had any further “mini-strokes” since the stenting.
