title: Emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to tandem occlusion.
abstract: OBJECTIVE
  Acute occlusions of the extracranial internal carotid artery (ICA) and a major intracranial artery respond poorly to intravenous tissue plasminogen activator (tPA) and present an endovascular challenge. The aim of our study was to retrospectively delineate the feasibility of the combined use of emergent carotid stenting and intra-arterial (IA) Abciximab with intracranial revascularization in the setting of acute ischemic stroke and carotid occlusions at our institution.
  
  
  METHODS
  Eleven patients with complete cervical carotid occlusion with or without concomitant intracranial ICA and/or MCA occlusion were identified from a single center, retrospective review of patients admitted to the Stroke unit. We evaluated all cases for complications of emergent cervical ICA recanalization employing carotid stenting and IA Abciximab.
  
  
  RESULTS
  All patients had complete cervical carotid occlusion with (n = 8) or without (n = 3) concomitant intracranial ICA and/or MCA occlusion. Successful emergent cervical ICA recanalization was achieved in all cases. All patients were administered IA Abciximab (dose range 6-17 mg, average 11.4 mg) immediately following the cervical carotid stenting. There was complete recanalization in all patients with no procedural morbidity or mortality. A single case (1/11, 9%) developed asymptomatic hemorrhagic transformation. Upon discharge, 9 patients (9/11, 82%) had a mRS of 0-2 and 2 patients (2/11, 18%) had a mRS of 3.
  
  
  CONCLUSIONS
  In acute ICA-MCA/distal ICA occlusions, extracranial stenting followed by intracranial IA Abciximab and thrombectomy appears feasible, effective, and safe. Further evaluation of this treatment strategy is warranted.
authors.affiliation: a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: b Department of Neurosurgery , Columbia University Medical Center , New York , NY , USA.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Manning
authors.affiliation: c Department of Neurology , University of Maryland Medical Center , Baltimore , MD , USA.
authors.forename: Imad
authors.initials: I
authors.lastname: Khan
authors.affiliation: d Department of Neurosurgery , University of Saskatchewan , Saskatoon , SK , Canada.
authors.forename: Lissa
authors.initials: L
authors.lastname: Peeling
authors.affiliation: a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA.
authors.forename: Chirag D
authors.initials: CD
authors.lastname: Gandhi
authors.affiliation: a Department of Neurosurgery , Rutgers University School of Medicine , Newark , NJ , USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
authors.affiliation: e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA.
authors.forename: Galyna
authors.initials: G
authors.lastname: Pushchinska
authors.affiliation: e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA.
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.affiliation: e Department of Neurosurgery , State University of New York at Stony Brook , Stony Brook , NY , USA.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Woo
mesh_terms: D000077284:Abciximab; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D016894:Endarterectomy, Carotid / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000628:therapy; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator; D000077284:Abciximab
keywords: Acute ischemic stroke; abciximab; carotid stenting