title: Stent-assisted endovascular recanalization of extracranial internal carotid artery occlusion in acute ischemic stroke.
abstract: OBJECTIVE
  Carotid artery occlusions traditionally have extremely poor outcomes with intravenous tissue plasminogen activator treatment or emergent thromboendarterectomy. We retrospectively reviewed our institutional experience with acute carotid occlusions using internal carotid artery endovascular thrombolysis and stent placement.
  
  
  METHODS
  We studied the radiographic and clinical characteristics of 17 patients with an acute cervical internal carotid artery occlusion treated with stent-assisted endovascular thrombolysis. Clinical outcomes were assessed by using National Institute of Health Stroke Scale (NIHSS) scores, which were obtained on admission and discharge. Inclusion criteria were an NIHSS score of at least 6 and the presence of significant penumbra on computed tomographic perfusion. Morbidity and mortality data were collected and analyzed.
  
  
  RESULTS
  Seventeen candidates met our inclusion criteria, 16 (94%) of whom had successful immediate recanalization of the internal carotid artery. On admission, the mean NIHSS score was 16.5 and the mean modified Rankin Scale score was 4.8. The mean NIHSS score improved to 6.9 on discharge, with a mean modified Rankin Scale score of 2.88. Eight (47%) patients recovered ambulatory function on discharge. The overall mortality rate of our series was 17%.
  
  
  CONCLUSIONS
  In the setting of acute ischemic stroke, emergent carotid artery thrombolysis and stenting is a promising treatment for acute carotid occlusions with excellent recanalization rates and favorable clinical outcomes.
authors.affiliation: Thomas Jefferson University Hospital, Jefferson Hospital for Neuroscience, Department of Neurosurgery, Philadelphia, Pennsylvania, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Dalyai
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: George
authors.initials: G
authors.lastname: Ghobrial
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods* / Q000401:mortality; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome