title: Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: a literature review.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion has a poor prognosis if treated by intravenous thrombolysis. Intra-arterial (IA) treatment is a promising alternative. However, its effectiveness is still unproven.
  
  
  METHODS
  We collected all publications describing results of IA treatment in acute ICA occlusions. All studies with 10 patients or more providing data on clinical outcome were included. We pooled the results by occlusion site (intracranial, extracranial or tandem occlusions) and treatment method, using recanalization, symptomatic intracranial hemorrhage, mortality and favorable clinical outcome (defined as modified Rankin Scale score 0-2) as outcome measures.
  
  
  RESULTS
  32 studies totaling 1107 patients were included. In the population with intracranial ICA occlusion, recanalization (69% vs 38%, p<0.001) and favorable outcome (34% vs 12%, p<0.001) rates were significantly higher for mechanical thrombectomy than for IA thrombolysis. In the population with extracranial ICA occlusion, stenting resulted in a higher recanalization rate (87% vs 48%, p=0.001) and favorable outcome rate (68% vs 15%, p<0.001) and lower mortality (18% vs 41%, p=0.048) than IA thrombolysis. In the tandem occlusion population, a statistically significant lower death rate was found for the group treated with IA thrombolysis only compared with the groups with any mechanical treatment of the intracranial occlusion (0% vs 34%, p=0.002 and 0% vs 33%, p=0.001).
  
  
  CONCLUSIONS
  This review shows that, for patients with AIS due to an extracranial and/or intracranial ICA occlusion, stenting and mechanical thrombectomy are associated with higher recanalization rates and improved functional outcomes compared with IA thrombolysis.
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: Kappelhof
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
mesh_terms: D001157:Arterial Occlusive Diseases / Q000628:therapy*; D002545:Brain Ischemia / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000473:pathology*; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects / Q000379:methods*; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D015607:Stents; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*
keywords: Intervention; Stent; Stroke; Thrombectomy; Thrombolysis