title: The Dotter method revisited: early experience with a novel method of rapid internal carotid artery revascularization in the setting of acute ischemic stroke.
abstract: BACKGROUND
  Tandem occlusive disease in the setting of acute ischemic stroke involving cervical and cerebral arteries has been associated with poor neurological outcome and poses significant challenges to neurointerventionists. Previously described endovascular methods typically involve carotid revascularization with stent placement prior to or following intracranial thrombectomy. Stent-based approaches, however, require the use of antiplatelet therapy which may increase the risk of hemorrhagic transformation. We describe a novel modified Dotter technique which may be used for carotid revascularization in lieu of stenting. This technique can eliminate the need for antiplatelet therapy, reduce procedure times, and possibly reduce hemorrhagic conversion rates.
  
  
  METHODS
  Seven patients presenting between April 2013 and January 2014 were treated with this technique. All patients had carotid stenosis of 65-100% and tandem middle cerebral artery occlusions. National Institutes of Health (NIH) Stroke Scale scores as well as clinical and procedural times were recorded. Pre- and post-Dotter stenosis was measured using the NASCET criteria. Follow-up imaging and clinical data were reviewed.
  
  
  RESULTS
  The mean age was 64 years and mean initial NIH Stroke Scale score was 11.7. Mean groin to recanalization time was 26 min. Thrombolysis In Cerebral Infarction grade 2b-3 was achieved in all patients. The mean stenosis was 88% preoperatively and 61% postoperatively. There were no intracranial hemorrhages. The modified Rankin Scale score was 0 in six patients (86%) and 6 in one patient (14%).
  
  
  CONCLUSIONS
  The Dotter stroke technique is a feasible and safe alternative to carotid stenting in the setting of acute ischemic stroke and may reduce the risk of hemorrhagic conversion. No re-occlusion occurred during follow-up in patients with post-Dotter stenosis ≤65%.
authors: Vista Radiology, Knoxville, Tennessee, USA.
authors: Keith
authors: K
authors: Woodward
authors: Vista Radiology, Knoxville, Tennessee, USA.
authors: Scott
authors: S
authors: Wegryn
authors: Fort Sanders Regional Medical Center, Knoxville, Tennessee, USA.
authors: Carla
authors: C
authors: Staruk
authors: Department of Radiology, University of Colorado, Aurora, Colorado, USA.
authors: Eric M
authors: EM
authors: Nyberg
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hemorrhage; Plaque; Stroke; Technique; Thrombectomy