Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke.
BACKGROUND
Endovascular therapy (ET) of internal carotid artery (ICA) stenosis is equivalent to carotid endarterectomy for stroke prevention; however, patients with ICA occlusion and acute symptoms are traditionally not candidates for ET. We report our experience in endovascular recanalization of acute stroke patients with ICA occlusion.


METHODS
We reviewed our registry for acute stroke patients treated with ET who had (1) ICA occlusion by digital subtraction angiography (thrombolysis in myocardial ischemia=0) with location of type II (above ophthalmic artery involving M1 or A1 but not both) or type III (proximal to the ophthalmic artery but distal to the bifurcation); (2) acute stroke symptoms from the index lesion presenting 3 hours after onset of symptoms; (3) minimal ischemic changes on brain CT scan (less than one third of the MCA territory); (4) attempted ET. Neuroradiologists reviewed angiograms for thrombolysis in cerebral infarction. A blinded vascular neurologist reviewed post-procedural brain imaging for Alberta Stroke Program Early CT (ASPECT) scoring. Outcome scales were assessed.


RESULTS
We identified 14 patients, 10 of whom were men (mean age, 58 +/- 14 years; median age, 54 years; age range, 40-74 years). There were 8 left ICA occlusions, 3 type II; and 6 right ICA occlusions, one type II. Median baseline National Institutes of Health Stroke Scale score was 17 (range, 11-25; mean, 18 +/- 4.9). Mean time to ET was 389 +/- 103 minutes (median, 306 minutes; range, 197-1290 minutes). Immediate recanalization occurred in 64%. Decrease in expected stroke volume by brain imaging occurred in 50% with mean ASPECT score of 4 +/- 2.9 (median, 3; range, 0-8; 21% > or = 8). Two hemorrhages occurred, one symptomatic; 3 patients died. Good outcome was achieved in 64% of cases.


CONCLUSIONS
Endovascular therapy of carotid occlusion in hyperacute stroke patients is feasible and may help to reduce stroke volume and increase good outcome in some patients.
Sugg
Rebecca M
RM
Department of Neurology, University of Texas-Houston Medical School, Houston, TX 77030, USA.
Malkoff
Marc D
MD
Noser
Elizabeth A
EA
Shaltoni
Hashem M
HM
Weir
Raymond
R
Cacayorin
Edwin D
ED
Grotta
James C
JC
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014656:Vascular Surgical Procedures
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator