title: Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke.
abstract: BACKGROUND
  We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.
  
  
  METHODS
  Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.
  
  
  RESULTS
  ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], .80-3.91; P = .16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P = .02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI, .42-11.43; P = .36) and 3-month mortality (OR, .53; 95% CI, .23-1.18; P = .12). Successful recanalization rate (Thrombolysis in Cerebral Infarction ≥2a) by EVT was 76%.
  
  
  CONCLUSIONS
  In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.
authors.affiliation: Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Jeong-Ho
authors.initials: JH
authors.lastname: Hong
authors.affiliation: Department of Neurology, Sungkyunkwan University Samsung Changwon Hospital School of Medicine, Changwon, Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
authors.forename: Min Uk
authors.initials: MU
authors.lastname: Jang
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Sang-Soon
authors.initials: SS
authors.lastname: Park
authors.affiliation: Department of Neurology, Soonchunhyang University College of Medicine, Asan, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yeungnam University School of Medicine, Daegu, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University Medical Center of Biostatistics, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: braindoc@snu.ac.kr.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Endovascular recanalization; acute stroke; carotid artery; revascularization; thrombolysis