Endovascular treatment of distal internal carotid artery occlusions with retrievable stents.
BACKGROUND
Acute stroke due to distal intracranial internal carotid artery (ICA) occlusion has a poor natural history. Outcome in patients who receive intravenous tissue plasminogen activator (tPA) is also unsatisfactory. The objective of this study is to evaluate the effectiveness and safety of endovascular treatment with retrievable stents in these patients.


METHODS
Data from a prospective register of patients with acute stroke treated with an endovascular procedure in a single centre were analysed.


RESULTS
A total of 20 patients with distal ICA occlusion were collected. Mean baseline National Institutes of Health Stroke Scale score was 18. Eight cases (40%) had received previous intravenous tPA. Mean time from stroke to recanalization was 393 min. Retrievable stents with proximal occlusion and aspiration were used in all cases. In 3 patients, 2 retrievable stents were used simultaneously. Complete recanalization (thrombolysis in cerebral infarction 2b/3) was accomplished in 85% of cases. A favourable clinical outcome (modified Rankin Scale score 0-2) was achieved in 13 patients (65%). Mortality occurred in 2 cases (10%).


CONCLUSIONS
Endovascular treatment of patients with distal ICA occlusion seems safe and effective. Retrievable stents may be the treatment of choice, although randomized clinical trials are necessary. The use of 2 retrievable stents at the same time could be an alternative technique useful in thrombi of larger size.
Department of Neurology and Radiology, Hospital Clínico San Carlos, Madrid, Spain.
Jordi A
JA
Matias-Guiu
Alberto
A
Gil
Carmen
C
Serna-Candel
Patricia
P
Simal
Ana M
AM
García-García
José A
JA
Egido
Jorge
J
Matías-Guiu
Luis
L
López-Ibor
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017546:Angioscopy / Q000295:instrumentation*; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome