Carotid and Cerebrovascular Disease

Emergent Endovascular Recanalization for Cervical Internal Carotid Artery Occlusion in Patients Presenting With Acute Stroke

Hauck EF, Natarajan SK, Ohta H, et al (Univ at Buffalo, NY) Neurosurgery 69:899–907, 2011^§

Abstract

Background

Acute proximal (cervical) internal carotid artery (ICA) occlusion may cause ischemia of an entire hemisphere or no ischemia at all, depending on the presence of intracranial collaterals.

Objective

To retrospectively analyze the clinical results for emergent endovascular carotid recanalization in patients with acute proximal (cervical) ICA occlusion and to assess predictors of recanalization and clinical, neurological, and functional outcome.

Methods

Emergent endovascular revascularization was attempted in 22 patients presenting with acute stroke secondary to complete cervical ICA occlusion. Patients with pseudo-occlusion were excluded. Recanalization was assessed with the Thrombolysis in Myocardial Ischemia (TIMI) system: grade 0 (no flow) to grade 3 (normal flow).

Results

The median age of the patients was 65 years; mean admission National Institutes of Health Stroke Scale (NIHSS) score was 14. Recanalization (TIMI grade 2/3) occurred in 17 patients (77.3%). Ten patients (45.5%) demonstrated significant clinical improvement during hospitalization (NIHSS improved ≥4 points). Fifty percent of patients had good outcomes (modified Rankin Scale ≤2) after a median follow-up of 3 months. Patient age <70 years and successful recanalization (TIMI grade 2/3) predicted a good outcome (P ≤ .01). Presence of atrial fibrillation, admission NIHSS score ≥20, and complete ICA occlusion at all levels (cervical, petrocavernous, and intracranial) were associated with poor outcomes (P ≤ .05). Patients with complete cervical ICA occlusion but partial distal preservation of the vessel were most likely to benefit from the intervention (recanalization in 88.2%; good outcome in 64.7%).

Conclusion

Attempts at emergent endovascular carotid recanalization for acute stroke are encouraged, particularly in younger patients with partial distal preservation of the ICA (Fig 2).

Figure 2 Angiographic images of the same patient as in Figure 1. A, digital subtraction angiogram, anteroposterior projection, intracranial view, before intervention. Notice the reconstitution of the internal carotid artery (ICA) distal to the petrocavernous segment via external carotid artery collaterals. B, digital subtraction angiogram, anteroposterior intracranial view, after intervention. Extensive filling of the left anterior and middle cerebral artery branches consistent with hyperperfusion. C, digital subtraction angiogram, lateral cervical view, before intervention demonstrating complete proximal (cervical) ICA occlusion. D, working view, distal microinjection. Notice the 9F Concentric balloon catheter (Concentric Medical) at the level of the carotid bifurcation with the Nautica microcatheter (ev3) advanced into the petrous ICA segment. The microrun confirms distal patency, suggesting likely recanalization with carotid stenting. E, digital subtraction angiogram, lateral view after deployment of a Wallstent (Boston Scientific) for successful ICA revascularization. Proximal protection was provided with balloon occlusion of the common carotid artery and simultaneous suction/aspiration. (Reprinted from Hauck EF, Natarajan SK, Ohta H, et al. Emergent endovascular recanalization for cervical internal carotid artery occlusion in patients presenting with acute stroke. Neurosurgery. 2011;69:899–907.)

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Function Testing of Platelets and Long-term Outcome of Patients with Peripheral Arterial Disease Undergoing Transluminal Angioplasty
2. of Hypoxia-Inducible Factor-1α Gene Therapy on Walking Performance in Patients With Intermittent Claudication
3. Proximal Endografting With Distal Bare-Metal Stenting for Management of Aortic Dissection
4. and Removal of Inferior Vena Cava Filters: National Trends in the Medicare Population

Stay updated, free articles. Join our Telegram channel

Join