title: Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke.
abstract: OBJECTIVE
  In past years, thrombectomy has become a widely used procedure in interventional neuroradiology for the treatment of acute intracranial occlusions. However, in 10-20% of patients, there are additional occlusions or stenotic lesions of the ipsilateral cervical internal carotid artery. The purpose of this study was to evaluate the feasibility of emergency carotid artery stent placement in combination with intracranial thrombectomy and the clinical outcome of the treated patients.
  
  
  METHODS
  We analyzed clinical and angiographic data of patients who underwent emergency cervical ICA stent placement and intracranial thrombectomy with stent-retriever devices in our institution between November 2009 and July 2012. Recanalization was assessed according to the Thrombolysis in Cerebral-Infarction score. Clinical outcome was evaluated at discharge (NIHSS) and after 3 months (mRS).
  
  
  RESULTS
  Overall, 24 patients were treated. The mean age was 67.2 years; mean occlusion time, 230.2 minutes. On admission, the median NIHSS score was 18. In all patients, the Thrombolysis in Cerebral Infarction score was zero before the procedure. Stent implantation was feasible in all cases. In 15 patients (62.5%), a Thrombolysis in Cerebral Infarction score ≥ 2b could be achieved. Six patients (25%) improved ≥10 NIHSS points between admission and discharge. After 90 days, the median mRS score was 3.0. Seven patients (29.2%) had a good clinical outcome (mRS 0-2), and 4 patients (16.6%) died, 1 due to fatal intracranial hemorrhage. Overall, symptomatic intracranial hemorrhage occurred in 4 patients (16.6%).
  
  
  CONCLUSIONS
  Emergency ICA stent implantation was technically feasible in all patients, and the intracranial recanalization Thrombolysis in Cerebral Infarction score of ≥2b was reached in a high number of patients. Clinical outcome and mortality seem to be acceptable for a cohort with severe stroke. However, a high rate of symptomatic intracranial hemorrhage occurred in our study.
authors.affiliation: From the Departments of Neuroradiology (S.S., M.M., C. Herweh, M.P., S.H., M.B., S.R.).
authors.forename: S
authors.initials: S
authors.lastname: Stampfl
authors.forename: P A
authors.initials: PA
authors.lastname: Ringleb
authors.forename: M
authors.initials: M
authors.lastname: Möhlenbruch
authors.forename: C
authors.initials: C
authors.lastname: Hametner
authors.forename: C
authors.initials: C
authors.lastname: Herweh
authors.forename: M
authors.initials: M
authors.lastname: Pham
authors.forename: J
authors.initials: J
authors.lastname: Bösel
authors.forename: S
authors.initials: S
authors.lastname: Haehnel
authors.forename: M
authors.initials: M
authors.lastname: Bendszus
authors.forename: S
authors.initials: S
authors.lastname: Rohde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods; D003131:Combined Modality Therapy; D004632:Emergency Medical Services / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome