title: Aggressive revascularization of acute internal carotid artery occlusion in patients with NIHSS>20 and poor collateral circulation: preliminary report.
abstract: BACKGROUND
  Acute occlusion of internal carotid artery (ICA) is a clinical catastrophic entity with mortality as high as 50%. With innovative devices and technology, we want to clarify the benefit and risk of interventional treatment for those patients.
  
  
  RESULTS
  From 2005 to 2009, 62 patients were enrolled and 7 patients were diagnosed as total ICA occlusion with severe neurological deficit and poor collateral circulation received endovascular interventions. Intra-arterial thrombolysis was performed in all the 7 patients. Besides, angioplasty was done in 2 patients, stenting in 3, and thrombosuction in 1. The average NIHSS was 23.3 (standard deviation=3.6) before revascularization, was 14.2(standard deviation=6.8) on day 7. Three patients had symptomatically hemorrhagic transformation and one developed severe brain edema after procedure. Decompressive craniotomy has been conducted in 3, who survived thereafter. One patient died for refusal of decompressive craniotomy. The 30-day modified Rankin scale was 1 in 1, 2 in 1, 3 in 1, and 4 in 3. All of our patients had distal residual lesions at anterior or middle cerebral artery area, and delayed recanalization was noted in 4.
  
  
  CONCLUSIONS
  Endovascular therapy was promising as a hyperacute management for patients of ICA total occlusion leading to survival rate more than 80% and significant neurological recovery in 50% of our patients. Distal residual lesions were common in patients of total carotid occlusion after aggressive revascularization. Although the mechanism was not clear, delayed re-canalization was common in such patients.
authors.affiliation: Cardiovascular Center, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Ai-Hsien
authors.initials: AH
authors.lastname: Li
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Wang
authors.forename: Hsiang-Fong
authors.initials: HF
authors.lastname: Kao
authors.forename: Lin-Hsue
authors.initials: LH
authors.lastname: Yang
authors.forename: Lung
authors.initials: L
authors.lastname: Chan
authors.forename: Shu-Hsun
authors.initials: SH
authors.lastname: Chu
authors.forename: Hon-Man
authors.initials: HM
authors.lastname: Liu
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures