title: Percutaneous recanalization of acute internal carotid artery occlusions in patients with severe stroke.
abstract: BACKGROUND
  Sudden symptomatic occlusions of the proximal internal carotid artery (ICA) resulting in severe middle cerebral artery (MCA) ischemia and stroke are usually not accessible by rt-PA thrombolysis and the prognosis is usually very poor. Mechanical recanalization of the proximal ICA combined with intravenous and intra-arterial thrombolysis was therefore used as a rescue procedure.
  
  
  METHODS
  Ten patients (9 men, 1 woman; mean age 56.1 years) were treated with emergency recanalization of the proximal carotid artery by using stents and/or balloon angioplasty as a rescue procedure. Three patients showed dissection, and 7 had atherothrombotic occlusions. Nine of 10 presented with an initial modified Rankin Scale (mRS) of 5, the remaining patient with mRS 4 (average NIHSS 21.4). After sonographic confirmation of ICA with associated MCA/distal ICA occlusion and bridging with rt-PA (without abciximab) an emergency angiography was performed with subsequent mechanical recanalization by percutaneous transluminal angioplasty (PTA) (n = 1) or primary stenting (n = 9) using self-expanding stents. Distal protection was used in 1 of 10 patients.
  
  
  RESULTS
  Recanalization of the proximal ICA was achieved in all. At least partial recanalization of the intracerebral arteries was achieved in all, and complete recanalization in 5. In 4 of 10 patients limited hemorrhage was detected during CT controls. Major complications included 2 patients who had to undergo hemicraniectomy. One patient died from malignant infarction. At the time of discharge from the stroke unit 9 of 10 patients had improved markedly, 5 patients having an mRS of < or =2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS < or =2, and 1 a mRS of 3.
  
  
  CONCLUSIONS
  Primary mechanical recanalization of ICA occlusions by stent and PTA combined with fibrinolysis and/or GPIIb/IIIa-receptor antagonists seems to be feasible to improve patient outcome significantly.
authors.affiliation: Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Dabitz
authors.forename: Stefan
authors.initials: S
authors.lastname: Triebe
authors.forename: Ullrich
authors.initials: U
authors.lastname: Leppmeier
authors.forename: Günther
authors.initials: G
authors.lastname: Ochs
authors.forename: Dierk
authors.initials: D
authors.lastname: Vorwerk
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome