Urgent Stenting for Patients With Acute Stroke Due to Atherosclerotic Occlusive Lesions of the Cervical Internal Carotid Artery

Abstract

Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. We retrospectively reviewed 10 patients treated by urgent CAS for atherosclerotic occlusive lesions of cervical ICA with acute stroke. Five patients had complete occlusions and five had near total occlusions. Five of the 10 patients had intracranial tandem occlusions. Indication for urgent CAS was determined by mismatch of diffusion-weighted and perfusion-weighted magnetic resonance imaging findings. Stents were successfully deployed in all lesions. Three of five patients with concomitant intracranial tandem occlusions were treated by additional intraarterial fibrinolysis after the CAS. Intracranial artery occlusions were completely recanalized in one patient, and partially recanalized in two by fibrinolysis. Hyperperfusion syndrome did not occur in any of the patients. A favorable outcome (modified Rankin Scale Ã1) was obtained in all of the five patients with isolated cervical ICA occlusion and one of the five patients with intracranial tandem occlusions. Urgent CAS is a safe and effective treatment in patients with isolated cervical ICA occlusion. Treatment of intracranial tandem occlusions is an issue that must be resolved.

Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: a literature review

“…The stenting group comprised four studies15 16 24 35 and a total of 38 patients (see online supplementary table S3). Overall outcome rates were 71% recanalization, 2% sICH, 28% mortality and 46% favorable outcome (see online supplementary table S4).…”

“…Overall outcome rates were 16% sICH, 45% mortality and 43% favorable outcome. We included three studies15 24 29 with intracranial IAT, comprising a total of 25 patients. Of this population, 15 patients (60%) showed sufficient recanalization.…”

“…Eleven patients (61%) recanalized. Seven studies15 16 24 33 34 39 42 with 197 patients described stenting of the extracranial ICA occlusion. Of these, 196 (99%) recanalized resulting in a statistically significant difference in recanalization rate compared with patients treated with IAT of the extracranial ICA (p<0.001).…”

Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion

“…Transient ischemia attack was seen in approximately one-third (13 of 40, 32.5%) of the patients, hemiplegia in about two-thirds (27 of 40, 67.5%) of the patients, and dysphasia in 30% (12 of 40) of the patients. The mean admission NIHSS score was 6.40 + 2.86 (range, 2-13), and the mean MoCA score was 14.80 + 3.43 (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Occlusion was noted in the right ICA in 5 (12.5%) patients, in the left ICA in 33 (82.5%) patients, and bilateral ICA in 2 (5%) patients.…”

Cerebral Hyperperfusion Syndrome After Angioplasty

“…A recent (<3 months) contralateral CEA is an additional potential risk factor for CHS and should also be considered in the timing of surgery (Ascher et al, 2003). Very few studies have addressed the use of CAS in hyperacute strokes, but those that have report good safety outcome (Miyamoto et al, 2008;Setacci et al 2010). Some authors (Henry et al, 2005;Lee et al, 2006) claim that treatment of both carotid arteries is feasible in carefully selected patients, either in the same procedure or in two procedures separated by an interval of one day; these authors report safety and complication rates comparable to those of large published series in high-risk patients.…”