title: Outcome and Treatment Effects in Stroke Associated with Acute Cervical ICA Occlusion.
abstract: BACKGROUND
  Endovascular therapy (EVT) with stent retrievers in addition to i.v. thrombolysis (IVT) has proven effective in acute stroke patients with middle cerebral artery (MCA, M1 segment) and distal internal carotid artery (ICA) occlusion. Limited data exist concerning acute cervical ICA occlusion, either alone or in combination with intracranial ICA occlusion (tandem occlusion). Therefore we analyzed outcome and treatment effects in stroke associated with cervical ICA occlusion, with specific focus on the impact of intracranial ICA or M1 patency.
  
  
  METHODS
  Seventy-eight patients with cervical ICA occlusion from our local stroke unit registry were analyzed retrospectively. Thrombolysis in Cerebral Infarction (TICI) classification, infarct size, modified Rankin scale (mRS), symptomatic intracerebral hemorrhage (ICH), and death were assessed as outcome parameters.
  
  
  RESULTS
  Forty-three patients had isolated cervical ICA occlusion whereas 35 patients presented with extra-/intracranial tandem occlusion. Patients underwent IVT alone (n = 23), combined IVT/EVT (n = 28) or no treatment (n = 27). Treated and untreated patients with tandem occlusion had a worse outcome after 90 days compared to isolated cervical occlusion (OR for moderate outcome 0.29, 0.27-0.88, p = 0.01). Additional EVT improved outcome in patients with tandem occlusion (OR for moderate outcome: 15.43, 1.60-148.90, p = 0.008) but not isolated cervical occlusion (OR 1.33, 0.38-11.60, NS).
  
  
  CONCLUSIONS
  In contrast to tandem occlusion, stroke outcome in patients with isolated cervical ICA occlusion was generally more benign and not improved by combined IVT/EVT compared to IVT alone. Intracranial vessel patency may be critical for treatment decision in acute cervical ICA occlusion.
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gliem
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: John-Ih
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: Aurica
authors.initials: A
authors.lastname: Barckhan
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D016017:Odds Ratio; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome