title: Acute ischemic stroke in the setting of cervical carotid occlusion: a proposed management strategy.
abstract: BACKGROUND
  Occlusion of the extracranial internal carotid artery, whether a result of atherothrombosis or dissection, is a challenging cause of ischemic stroke, characterized by a dismal natural history and a poor response to systemic thrombolysis.
  
  
  METHODS
  Review of the literature and proposal of a management strategy.
  
  
  RESULTS
  In most patients, symptoms are caused by a coexistent intracranial occlusion, and treatment of the latter dictates the final outcome. However, a smaller subset of patients present with acute cerebral hemodynamic insufficiency requiring recanalization of the extracranial vessel. Careful analysis of the initial angiograms, particularly the extent and pattern of collateral flow, will usually give the clue as to the mechanism of stroke. The distal lesion can often be accessed by advancing a microcatheter, either through collateral channels or through the proximal occlusion itself.
  
  
  CONCLUSIONS
  In all cases, the importance of prompt and timely recanalization through aggressive intra-arterial therapy cannot be overemphasized.
authors.affiliation: Department of Neurosurgery, University of Cincinnati, Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Rahme
authors.forename: Todd A
authors.initials: TA
authors.lastname: Abruzzo
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ringer
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D002548:Cerebral Revascularization / Q000379:methods; D002941:Circle of Willis / Q000601:surgery; D003097:Collateral Circulation; D019468:Disease Management; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator