Recanalization of acute symptomatic occlusions of the internal carotid artery

Meves, Saskia H.; Muhs, A.; Federlein, Jens; Büttner, Thomas; Przuntek, H.; Postert, Thomas

doi:10.1007/pl00007863

Cited by 59 publications

(59 citation statements)

References 19 publications

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“…2,3 In this group of patients, early restoration of flow in the occluded ICA may improve the symptoms of acute stroke, prevent stroke deterioration, and reduce the long-term stroke recurrence risk. Some authors have reported successful revascularization of patients with acute stroke symptoms secondary to ICA occlusions.…”

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confidence: 99%

Predictors of Functional Outcome after Emergency Carotid Artery Stenting and Intra-Arterial Thrombolysis for Treatment of Acute Stroke Associated with Obstruction of the Proximal Internal Carotid Artery and Tandem Downstream Occlusion

Kwak

Hwang

Jin

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Patients who develop severe stroke symptoms due to acute internal carotid artery occlusion eventually in combination with a thromboembolic obstruction of the middle cerebral artery incur a major risk of developing extensive MCA infarction with a poor outcome. The purpose of this study was to evaluate the outcome for patients with tandem occlusions in the MCA and/or distal ICA, retrospectively, who had undergone stent implantation in the proximal segment of the ICA in addition to intra-arterial thrombolysis.

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confidence: 99%

Predictors of Functional Outcome after Emergency Carotid Artery Stenting and Intra-Arterial Thrombolysis for Treatment of Acute Stroke Associated with Obstruction of the Proximal Internal Carotid Artery and Tandem Downstream Occlusion

Kwak

Hwang

Jin

et al. 2012

AJNR Am J Neuroradiol

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“…2,[16][17][18] The rate of recanalization is dependent on several factors, such as the type of acute treatment and the segment affected. 17,19 This is the first study with a prospective design on the occurrence of a residual high-grade stenosis after recanalization of an extracranial ICA occlusion in the acute stage of cerebral ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…18 Two smaller studies reported a residual high-grade stenosis in 1 of 12 (8.3%) patients and 2 of 20 (10.0%) patients, respectively. 2,16 More than half of the patients with a residual high-grade stenosis in our study population underwent CEA or carotid stenting. In addition, CEA could also be considered in patients with a residual stenosis of 50% to 69%.…”

Section: Discussionmentioning

confidence: 99%

“…1 Recanalization after an occlusion of the ICA in the acute stage may occur more commonly than previously assumed. 2 If a high-grade stenosis persists after recanalization, this may have important implications for subsequent treatment because the recurrence rate of ischemic stroke in patients with high-grade stenosis within 7 days is ≈8%. 3,4 Carotid endarterectomy (CEA) has proven to be beneficial in patients with a ≥70% stenosis without near occlusions, and it is recommended within 2 weeks after the first symptoms.…”

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confidence: 99%

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Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke

Luitse

Velthuis

Dauwan

et al. 2015

Stroke

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Background and Purpose-Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (≥70%, near occlusions not included) on follow-up imaging in a consecutive series of patients with an acute symptomatic occlusion of the extracranial ICA. Methods-We included patients participating in the Dutch Acute Stroke Study (DUST), who had an acute symptomatic occlusion of the extracranial ICA that was diagnosed on computed tomographic angiography within 9 hours after onset of neurological symptoms. Follow-up imaging of the carotid artery had to be available within 7 days after admission. Results-Of the 1021 patients participating in DUST between May 2009 and May 2013, an acute symptomatic occlusion of the extracranial ICA was found in 126 (12.3%) patients. Follow-up imaging was available in 86 (68.3%) of these patients. At follow-up, a residual stenosis of <30% was found in 15 (17.4%; 95% confidence interval, 10.8-26.9) patients, a 30% to 49% stenosis in 3 (3.5%; 95% confidence interval, 0.8-10.2) patients, a 50% to 69% stenosis in 2 (2.3%; 95% confidence interval, 0.1-8.6) patients, and a ≥70% stenosis in 14 (16.3%; 95% confidence interval, 9.8-25.6) patients. A near or persistent occlusion was present in the remaining 52 (60.5%) patients. Conclusions-A residual high-grade stenosis of the extracranial ICA occurs in 1 of 6 patients with a symptomatic occlusion in the acute stage of cerebral ischemia. Because this may have implications for secondary prevention, we recommend follow-up imaging in these patients within a week after the event. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.

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“…This aside, we have found only a few cases of ICA SR at its origin or in its siphon, demonstrated by USG or AG, in the literature [5][6][7][8][9][10][11][12] . So far to date, no reliable data have been published on the incidence and clinical consequences of SR of the extracranial ICA occlusion 6 .…”

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confidence: 99%

An Uncommon Case of Spontaneous Resolution of Mural Thrombus Causing Symptomatic Severe Stenosis of the Extracranial Part of the Internal Carotid Artery

Labonek¹,

Šaňák²,

Herzig³

et al. 2006

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Objectives: Etiology of ischemic stroke(IS) remains sometimes unexplained in younger subjects. Its well-known causes are atherosclerosis(AS), embolization, arterial dissection, congenital defects, vasculitides, smoking, use of oral contraceptives, coagulopathy and arterial dissection, or vasospasm.Case report: A 54-year old male subject was examined because of motor disturbance in his left upper extremity. Computerized tomography(CT) of the brain did not detect any focal pathological changes. Utrasonographic(USG) examination revealed severe stenosis of the right internal carotid artery(ICA) caused by hypoechogenic material, the blood velocity beyond the stenosis was 240 cm/s. The USG finding was confirmed by digital subtraction angiography (DSA). Based on the results of these examinations, an acute carotid endarterectomy (CEA) was indicated. During CEA the vascular surgeon observed patency of the ICA with only small calcified AS plaque on its posterior side. Ultrasonographic examination, performed on the 5 th day, showed a small calcified AS plaque on the posterior side of the right ICA. Conclusion:In conclusion, if we exclude the possibility of a false positivity of 2 imaging methods at once, we have encountered a very unusual case of SR of stenosing material in the extracranial part of the ICA, initially causing its severe stenosis manifesting by acute neurological symptomatology. The mechanism of this SR remains unclear and the problem should be further studied, preferably using less invasive AG methods.

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Recanalization of acute symptomatic occlusions of the internal carotid artery

Abstract: The present study showed that recanalization of the occluded ICA in acute stroke patients is more frequent than generally presumed. CCDS should be routinely performed in the follow-up of stroke patients as spontaneous recanalization may influence clinical outcome.

Cited by 59 publications

References 19 publications

Predictors of Functional Outcome after Emergency Carotid Artery Stenting and Intra-Arterial Thrombolysis for Treatment of Acute Stroke Associated with Obstruction of the Proximal Internal Carotid Artery and Tandem Downstream Occlusion

Predictors of Functional Outcome after Emergency Carotid Artery Stenting and Intra-Arterial Thrombolysis for Treatment of Acute Stroke Associated with Obstruction of the Proximal Internal Carotid Artery and Tandem Downstream Occlusion

Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke

An Uncommon Case of Spontaneous Resolution of Mural Thrombus Causing Symptomatic Severe Stenosis of the Extracranial Part of the Internal Carotid Artery

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