title: Endovascular interventions for patients with serious symptoms caused by embolic carotid T occlusion.
abstract: The efficacy of endovascular interventions based on magnetic resonance (MR) imaging for acute ischemic stroke caused by embolic carotid T occlusion was assessed. Endovascular intervention was performed in 10 of 751 consecutive acute ischemic stroke patients admitted to our institution between April 2001 and July 2003. Indications were: presentation within 6 hours of onset of cardioembolic stroke; National Institute of Health Stroke Scale (NIHSS) score ≥ 10 on admission; absence of extensive signal hyperintensity on diffusion-weighted imaging; and carotid T occlusion on angiography. Localized intra-arterial thrombolysis using urokinase and/or mechanical clot disruption using micro-balloon catheter were performed. Radiographic findings, ΔNIHSS defined as NIHSS on day 7 - NIHSS on admission, 3-month modified Rankin scale (mRS), 3-month mortality, and symptomatic intracranial hemorrhage (ICH) were evaluated. Partial recanalization was achieved in 5 of 10 patients, but no recanalization was obtained in 5 patients. No significant differences in 3-month mRS (0-2) or symptomatic ICH were identified between these groups. However, the partial recanalization group showed significantly better clinical outcomes (median 3-month mRS 3 vs. 6, p = 0.009) and lower mortality rate at 90 days (0% vs. 80%, p = 0.047) with significantly greater ΔNIHSS (-8 vs. +6, p = 0.009). Endovascular intervention based on MR imaging resulting in partial recanalization may reduce poor outcomes and mortality in patients with embolic carotid T occlusion. Improvement of the outcomes of such patients requires more efficient methods such as clot retrieval therapy.
authors.affiliation: Department of Neurology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takahisa
authors.initials: T
authors.lastname: Mori
authors.forename: Keisuke
authors.initials: K
authors.lastname: Imai
authors.forename: Hajime
authors.initials: H
authors.lastname: Izumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D002341:Carotid Artery Thrombosis / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000473:pathology; D002533:Cerebral Angiography; D017128:Embolectomy / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome