[Indication for emergent revascularisation of acute carotid occlusion].
OBJECTIVE
We examined indications for emergent revascularisation of acutely occluded internal carotid artery (ICA) using current diagnostic methods.


METHODS
From 1997 to 2006 we prospectively followed 34 consecutive patients undergoing emergency revascularisation due to acute extracranial ICA occlusion and acute ischaemic stroke within 72 h after symptom onset (mean 25) and within 36 h after admission (mean 16). Exclusion criteria were occlusion of the intracranial ICA or ipsilateral middle cerebral artery (MCA), ischaemic infarction of more than one third of the MCA perfusion area, or reduced level of consciousness. All patients underwent duplex sonography, cerebral CT, and/or MRI and angiography (MRA and/or DSA). We performed endarterectomy and thrombectomy of the ICA.


RESULTS
Confirmed by postoperative duplex sonography at discharge, ICA revascularisation was successful in 30 (88%) of 34 cases. Postoperative intracranial haemorrhage was detected in two patients (6%) and perioperative reinfarction in one (3%). Compared to the preoperative status, 20 patients (59%) showed signs of clinical improvement by at least one point on the Rankin scale, ten patients (29%) remained stable, and two patients (6%) had deteriorated. The 30-day mortality was 6% (two patients).


CONCLUSIONS
After careful diagnostic workup, revascularisation of acute extracranial ICA occlusion is feasible with low morbidity and mortality.
Weis-Müller
B T
BT
Klinik für Gefässchirurgie und Nierentransplantation, Uniklinikum der Heinrich-Heine-Universität, Moorenstrasse 5, Düsseldorf, Germany. MuellerB@med.uni-duesseldorf.de
Huber
R
R
Spivak-Dats
A
A
Turowski
B
B
Seitz
R
R
Siebler
M
M
Sandmann
W
W
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003952:Diagnostic Imaging; D004630:Emergencies; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate; D014680:Veins / Q000637:transplantation