title: Endovascular treatment in patients with acute ischemic stroke and apparent occlusion of the extracranial internal carotid artery on CTA.
abstract: BACKGROUND
  Intra-arterial treatment is gaining importance in acute ischemic stroke, but its role in patients with apparent occlusion of the extracranial internal carotid artery (ICA) on computed tomographic angiography (CTA) is inconclusive.
  
  
  OBJECTIVE
  To review retrospectively the results of intra-arterial treatment in patients with stroke and apparent extracranial ICA occlusion.
  
  
  METHODS
  In more than 3000 patients with stroke admitted to our institution during 2008-2013, and the subgroup with suboptimal results after intravenous thrombolysis (IVT), CTA showed the absence of contrast in the extracranial ICA in 16 patients. Angiography showed true occlusion of the extracranial ICA in 10 and pseudo-occlusion in 6 patients. Treatment was considered technically successful when Thrombolysis in Cerebral Infarction scale (TICI) scores improved to 2 or 3 and clinically successful when the National Institutes of Health Stroke Scale (NIHSS) improved by at least 10 points or a NIHSS score of 0 or 1 was found at discharge.
  
  
  RESULTS
  Recanalization was achieved in 5 of 6 patients with pseudo-occlusions and in 6 of 10 patients with true occlusion of the extracranial ICA. Favorable clinical outcomes were seen in 3 of 6 patients with pseudo-occlusions and in 4 of 10 patients with true occlusions. Four patients died, and in these patients infarction of >15% of the affected hemisphere had been seen on admission CT.
  
  
  CONCLUSIONS
  In cases of acute stroke and apparent occlusion of the extracranial ICA, intra-arterial treatment should be considered, especially when IVT fails and <15% of the hemisphere is infarcted on CT. Endovascular treatment may be beneficial especially in pseudo-occlusions but also in true occlusions of the extracranial ICA.
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Hanneke M
authors.initials: HM
authors.lastname: Duijsens
authors.affiliation: Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Fianne
authors.initials: F
authors.lastname: Spaander
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Lukas C
authors.initials: LC
authors.lastname: van Dijk
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Frank E
authors.initials: FE
authors.lastname: Treurniet
authors.affiliation: Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Keunen
authors.affiliation: Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Arne
authors.initials: A
authors.lastname: Mosch
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: van Overhagen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*
keywords: CT Angiography; Stent; Stroke; Thrombectomy; Thrombolysis