Endovascular Treatment of Acute Thrombotic Occlusion of the Cervical Internal Carotid Artery Associated with Embolic Occlusion of the Middle Cerebral Artery

Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage

“…The risk of ischemic stroke related to recanalization of a completely occluded ICA is believed to be high. 17 However, if a protection device is used, as shown in our series as well as that of Kao et al, ischemic stroke might be prevented even in a series with complete occlusion. The other possible risk related to endovascular recanalization was hyperperfusion syndrome.…”

Intra-arterial Thrombolysis of Embolic Middle Cerebral Artery Using Collateral Pathways

“…The operator should first attempt to traverse the occluded cervical internal carotid artery with a microcatheter to reach the intracranial embolus, 2,4 but if this is not immediately successful, we advocate using the Circle of Willis collaterals, preferably via the anterior communicating artery or, if not possible as in our two cases, via the posterior circulation. Circle of Willis collaterals are not always present and spending an inordinate amount of time trying to navigate through the anterior or posterior communicating artery is not recommended and may be equally risky.…”

“…1,2 Most neurointerventionalists recommend catheter navigation through the occluded cervical carotid artery with or without angioplasty and stenting. 1,2,4,[6][7][8] This commonly used approach, while often successful at allowing access to the middle cerebral artery, can be time consuming and there are potential complications. We present two patients with acute, embolic MCA occlusion in association with occluded cervical ICAs, treated by intra-arterial thrombolysis via the posterior communicating artery collateral pathway.…”

Carotid endarterectomy and intracranial thrombolysis: Simultaneous and staged procedures in ischemic stroke

“…It has been shown in several studies that thrombolytic agents, given either intravenously or intraarterially, can be successful in recanalizing an acute occlusion of the MCA. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Because thrombolytic therapy cannot be effective in the treatment of an embolizing carotid focus, a combined approach, consisting of thrombolysis and extracranial CEA either as a staged or simultaneous procedure, might be a promising therapeutic option in the management of acute carotid-related ischemic stroke. 31 Additionally, intraoperative thrombolysis might be indicated in elective CEA complicated by intraoperative intracranial embolism.…”