Emergent Combined Intracranial Thrombolysis and Carotid Stenting in the Hyperacute Management of Stroke Patients with Severe Cervical Carotid Stenosis

Abstract

BACKGROUND AND PURPOSE:The timely re-establishment of intracranial perfusion, the effective prevention of early recurrent strokes, and the limitation of the incidence of reperfusion injury are the major factors that are key to successful treatment of patients with hyperacute stroke who had severe ipsilateral cervical internal carotid artery (ICA) stenosis. In an effort to reduce both the extent of the ongoing neurologic injury and the risk of early recurrent stroke, we have adopted an aggressive combined endovascular approach of intracranial thrombolysis and cervical carotid stent placement during the hyperacute phase. We report on the results of 5 such consecutive patients who

Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience

“…The main focus of previous studies has been the procedure itself and short-term clinical results; information regarding follow-up vascular investigations has been reported in only four studies 4 5 9 10. Of the patients included in these studies, only one showed asymptomatic moderate stenosis of approximately 40% 5.…”

Intravenous Thrombolysis for Acute Ischemic Stroke due to Cervical Internal Carotid Artery Occlusion

“…34,35 Several of these studies show that endovascular therapy appears to convey a benefit over IV-tPA alone in acute strokes involving the ICA. 8,10,11 With the advent of endovascular therapy used in combination with IV-tPA, the careful preselection of suitable patients is crucial in maximizing clinical outcomes. Our study findings propose important factors to consider in selecting extracranial ICA occlusion patients for revascularization treatment using IV-tPA.…”

“…[7][8][9] Only few studies have focused on the response to IV-tPA in patients with primary acute occlusion of cervical ICA. [10][11][12] These disparate populations may have different hemodynamic properties and response to IV-tPA. 8 We identified AIS patients with primary occlusion of cervical ICA from our thrombolysis cohort and analyzed them for the determinants of functional outcome.…”

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

“…Furthermore, several studies have reported CAS as effective for symptomatic carotid stenosis 1) . Additionally, the number of studies reporting the effectiveness and safety of CAS for AIS are growing 19,27,41,44) . However, the evidence supporting CAS for AIS was not established in the 2018 guideline.…”