Prognostic factors for neurologic outcome after endovascular revascularization of acute symptomatic occlusion of the internal carotid artery.
OBJECTIVE
Management of acute symptomatic internal carotid artery (ICA) occlusion remains controversial. We evaluated outcome predictors of a good recovery in patients with acute symptomatic ICA occlusion.


METHODS
We retrospectively evaluated 33 consecutive patients (men/women, 23/10; mean age, 66 years) with: 1) acute symptomatic ICA occlusion within 6 hours of symptom onset or with mismatch of symptoms and an early infarct area, 2) National Institutes of Health Stroke Scale (NIHSS) score of 6 or more, and 3) attempted endovascular revascularization of the occluded ICA. Various single and multiple variable analyses were conducted to assess the association of 14 predictors with short-term (1-month NIHSS) and long-term (1-year modified Rankin Scale [mRS]) outcomes.


RESULTS
Successful recanalization (at or more than grade 2 distal residual occlusion) was obtained in 14 (42%) of 33 and good recovery (mRS <or=2) after 1 year in 11 (33%) of 33. Distal residual occlusion (DRO; P=.005), initial NIHSS score (P=.023), and postprocedural thrombolysis in cerebral infarction (P=.027), retrograde ICA filling (P=.036), and ophthalmic collaterals (P=.046) were significant predictors of short-term outcome. DRO (P=.018) and initial NIHSS (P=.033) were significant predictors of long-term outcome on univariable analysis. DRO was the only significant predictor for short-term (P=.026) and long-term outcome (P=.033) on multivariable logistic regression.


CONCLUSIONS
Active revascularization of acute symptomatic ICA occlusion resulted in good recovery in one third of patients after 1 year. DRO is an independent predictor of a favorable clinical outcome.
Suh
D C
DC
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. dcsuh@amc.seoul.kr
Kim
J K
JK
Choi
C G
CG
Kim
S J
SJ
Pyun
H W
HW
Ahn
C
C
Yang
D H
DH
Lim
K S
KS
Leem
J-G
JG
Hahm
K D
KD
Lee
J-H
JH
Kwon
S U
SU
Kim
J S
JS
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome