title: Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery.
abstract: OBJECTIVE
  Endovascular therapy is used increasingly for treatment of acute symptomatic internal carotid artery (ICA) occlusion, although randomized trials are lacking. Predictors of outcome are therefore of special interest.
  
  
  METHODS
  From 1992 to 2010 we treated 201 patients with acute ICA occlusion with intra-arterial pharmacological thrombolysis (32), endovascular mechanical therapy (78) or a combination of both (91). All data were assessed prospectively.
  
  
  RESULTS
  There were 76/38% patients with tandem occlusions [ICA plus middle (MCA) or anterior cerebral arteries (ACA)], 18/9% without concomitant occlusions of major intracranial arteries (ICA plus branch occlusion) and 107/53% with functional ICA-T occlusions (ICA plus MCA and ACA). Median baseline National Institute of Health Stroke Scale (NIHSS) score was 17. Good recanalization (Thrombolysis in Myocardial Infarction 2-3) was achieved in (157/201) 78% patients and good reperfusion (Thrombolysis in Cerebral Infarction 2-3) in (151/182) 83%. Better recanalization rates were obtained with mechanical approaches, with/without thrombolytics (78/91 = 86% and 64/78 = 82%) compared with pharmacological thrombolysis only (15/32 = 47%; P < 0.001). Twelve patients (6%) suffered symptomatic intracranial haemorrhages. The 3-month outcome was favourable [modified Rankin score (mRS) 0-2] in 54/28% patients and moderate (mRS 0-3) in 90/46%; 60/31% patients died. Only 17/16% patients with functional ICA-T occlusions had favourable outcomes compared with 32/44% with tandem occlusions and 5/31% with ICA plus cerebral branch occlusions (P = 0.001). In multivariate analysis age [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93-0.98], NIHSS on admission (OR = 0.9, 95% CI = 0.83-0.98) and functional ICA-T occlusion (OR = 0.35, 95% CI = 0.16-0.77) were non-modifiable predictors, and vessel recanalization was the only modifiable predictor of outcome (OR = 9.30, 95% CI = 2.03-42.63).
  
  
  CONCLUSIONS
  The outcome of acute symptomatic ICA occlusion is poor. However, recanalization is associated with better outcome, and recanalization rates with mechanical techniques were superior to merely pharmacological recanalization attempts.
authors: Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
authors: U
authors: U
authors: Fischer
authors: M-L
authors: ML
authors: Mono
authors: G
authors: G
authors: Schroth
authors: S
authors: S
authors: Jung
authors: P
authors: P
authors: Mordasini
authors: M
authors: M
authors: El-Koussy
authors: A
authors: A
authors: Weck
authors: C
authors: C
authors: Brekenfeld
authors: O
authors: O
authors: Findling
authors: A
authors: A
authors: Galimanis
authors: M R
authors: MR
authors: Heldner
authors: M
authors: M
authors: Arnold
authors: H P
authors: HP
authors: Mattle
authors: J
authors: J
authors: Gralla
mesh_terms: D002341:Carotid Artery Thrombosis / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000187:drug effects* / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D011446:Prospective Studies; D015424:Reperfusion; D012307:Risk Factors; D015912:Thrombolytic Therapy; D016896:Treatment Outcome