Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents

Illustrative case (patient 13). A and B, Lateral DSA images demonstrate a tapered and severely narrowed left ICA dissection with flow limitation that extends across the cervical segment into the skull base. C, Anteroposterior DSA image of an aspiration thrombectomy catheter navigated across the left ICA cervical dissection and placed just proximal to the M1 segment thromboembolus. D, Lateral DSA image demonstrates successful thrombolysis/thrombectomy, resulting in complete recanalization and eventual TICI 3 reperfusion of the left MCA distribution. E–H, Serial anteroposterior DSA images demonstrate stent reconstruction of the long-segment left ICA dissection after MCA thrombectomy, distal to the petrocavernous junction into the proximal cervical left ICA, resulting in near-normal vessel caliber, with no residual stenosis or flow limitation. Note spontaneous thrombosis of the carotid pseudoaneurysm (arrow) and no residual subintimal contrast in the midcervical segment after stent-induced apposition of the intimal flap.