Management of Patients With Atherosclerotic Carotid Occlusion

Abstract

• Patients with acute ischemic stroke due to atherosclerotic carotid artery occlusion (ACAO) should receive intravenous tissue plasminogen activator (alteplase) if they meet eligibility criteria of the National Institute of Neurological Disorders and Stroke (NINDS) or the European Cooperative Acute Stroke Study III (ECASS III). • Patients with acute stroke due to ACAO who are not eligible for intravenous tissue plasminogen activator should receive aspirin. Heparin or heparin-like drugs do not improve outcome and should not be used. • Therapy for prevention of recurrent stroke in patients with ACAO should consist of lifestyle modifications, risk factor intervention, and antiplatelet drugs. Warfarin is not indicated. • Extracranial-intracranial bypass surgery provides no benefit over medical therapy in preventing recurrent stroke in a general population of patients with ACAO or in any subgroups selected by clinical, arteriographic, or hemodynamic criteria. • Other surgical or endovascular procedures have no proven value in treating or preventing stroke due to ACAO. • Asymptomatic carotid occlusion has a benign prognosis and requires no specific treatment other than lifestyle modification and risk factor intervention.

A Complete Occlusion of Common Carotid Artery- A Case Report

“…As a result, establishing patency of the ICA and ECA is essential prior to an intervention. [13,14,15]. Several small series reported in the literature have shown excellent revascularization results in relieving the symptoms of cerebral ischemia.…”

Management of Bilateral Carotid Occlusive Disease

“…While these studies are highly sensitive, they can often misclassify high-grade stenosis as an occlusion (pseudo-occlusion) [19]. Since the management of carotid occlusion and high-grade stenosis may be different [4], a catheter-based study is essential in characterizing the true degree of stenosis and to further clarify the nature of collateral anastomosis. All 3 patients in this study demonstrated collateral flow through the posterior communicating and ophthalmic arteries, which likely accounts for the mildness of the presenting symptoms.…”

“…Patients with bilateral carotid occlusion were excluded from the Carotid Occlusion Surgery study as PET imaging cannot be reliably applied as selection criteria in the context of bihemispheric disease. The best management of this subset of patients is unclear [4]. …”

Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia

“…3,4 To address this issue, we analyzed data from the nonsurgical group of the Carotid Occlusion Surgery Study (COSS).…”

“…[1][2][3] Disagreement exists whether strict blood pressure (BP) control is the best medical management for these patients or whether higher BPs are needed to preserve cerebral perfusion and prevent subsequent stroke. 3,4 To address this issue, we analyzed data from the nonsurgical group of the Carotid Occlusion Surgery Study (COSS). 2 …”