Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke

Rebecca M. Sugg, Marc D. Malkoff, Elizabeth A. Noser, Hashem Shaltoni, Raymond Weir, Edwin D. Cacayorin, James C. Grotta

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

BACKGROUND: Endovascular therapy (ET) of internal carotid arten (ICA) stenosis is equivalent to carotid endarterectomy for stroke prevention; however, patients with ICA occlusion and acute symptoms are traditionally not candidates for ET. We report our experience in endovascular recanalization of acute stroke patients with ICA occlusion. PATIENTS AND TECHNIQUES: We reviewed our registry for acute stroke patients treated with ET who had (1) ICA occlusion by digital subtraction angiography (thrombolysis in myocardial ischemia = 0) with location of type II (above ophthalmic artery involving M1 or A1 but not both) or type III (proximal to the ophthalmic artery but distal to the bifurcation); (2) acute stroke symptoms from the index lesion presenting 3 hours after onset of symptoms; (3) minimal ischemic changes on brain CT scan (less than one third of the MCA territory); (4) attempted ET. Neuroradiologists reviewed angiograms for thrombolysis in cerebral infarction. A blinded vascular neurologist reviewed postprocedural brain imaging for Alberta Stroke Program Early CT (ASPECT) scoring. Outcome scales were assessed. RESULTS: We identified 14 patients, 10 of whom were men (mean age. 58 ± 14 years; median age, 54 years: age range, 40-74 years). There were 8 left ICA occlusions, 3 type II; and 6 right ICA occlusions, one type II. Median baseline National Institutes of Health Stroke Scale score was 17 (range, 11-25; mean, 18 ± 4.9). Mean time to ET was 389 ± 103 minutes (median, 306 minutes; range, 197-1290 minutes). Immediate recanalization occurred in 64%. Decrease in expected stroke volume by brain imaging occurred in 50% with mean ASPECT score of 4 ± 2.9 (median, 3: range, 0-8; 21% ≥ 8). Two hemorrhages occurred, one symptomatic; 3 patients died. Good outcome was achieved in 64% of cases. CONCLUSION: Endovascular therapy of carotid occlusion in hyperacute stroke patients is feasible and may help to reduce stroke volume and increase good outcome in some patients.

Original languageEnglish (US)
Pages (from-to)2591-2594
Number of pages4
JournalAmerican Journal of Neuroradiology
Volume26
Issue number10
StatePublished - Dec 1 2005
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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    Sugg, R. M., Malkoff, M. D., Noser, E. A., Shaltoni, H., Weir, R., Cacayorin, E. D., & Grotta, J. C. (2005). Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke. American Journal of Neuroradiology, 26(10), 2591-2594.