title: Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients.
abstract: OBJECTIVE
  Acute occlusion of the carotid-T is associated with large ischemic lesions, poor outcome and up to 53 % mortality with conservative therapy. Endovascular mechanical thrombectomy (EMT) is a promising alternative treatment of large vessel occlusion. Here, we examine feasibility, safety and efficiency of EMT in acute ischemic stroke due to carotid-T-occlusion.
  
  
  METHODS
  Single centre, retrospective analysis of 51 consecutive patients with acute occlusion of the carotid-T, treated by EMT within 6 h after symptom onset. Most patients (42/51) were treated with stentretrievers, 33 with stentretrievers only. Recanalization was assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Early and mid-term clinical outcome was evaluated by National Institutes of Health Stroke Scale (NIHSS)- and modified Rankin Scale mRS-scores, respectively.
  
  
  RESULTS
  Successful recanalization (TICI 2b/3) was achieved in 78.4 % (40/51). Good clinical outcome (mRS 0-2) was observed in 24.4 % of patients, and only in patients treated successfully (TICI 2b/3). Stentretrievers yielded higher recanalization rates and better clinical outcomes than non-stentretriever devices. A total of 12 patients died (29.3 %) during the 90-day observation period. Clinically relevant procedure-related complications occurred in two patients, consisting in one vessel perforation with a microwire, and one symptomatic parenchymal haemorrhage after initiation of antiplatelet therapy following the inadvertent detachment of a stentretriever. Another symptomatic haemorrhage, not directly procedure-related, occurred in one additional patient.
  
  
  CONCLUSIONS
  EMT in acute carotid-T-occlusion is efficient, yielding high recanalization rates, and reasonably safe, with a low rate of clinically relevant complications. Successful recanalization seems to be a prerequisite for good clinical outcome in this severe condition.
authors: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors: Daniela
authors: D
authors: Frahm
authors: Klinikum rechts der Isar, Neurological Clinic and Policlinic, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors: Silke
authors: S
authors: Wunderlich
authors: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors: Mirjam I
authors: MI
authors: Schubert
authors: Klinikum rechts der Isar, Neurological Clinic and Policlinic, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors: Holger
authors: H
authors: Poppert
authors: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. justus.kleine@tum.de.
authors: Justus F
authors: JF
authors: Kleine
authors: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors: Sascha
authors: S
authors: Prothmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute ischemic stroke; Carotid T occlusion; Endovascular therapy; Mechanical thrombectomy; Outcome; Recanalization