Percutaneous recanalization of acute internal carotid artery occlusions in patients with severe stroke

Cardiovasc Intervent Radiol. 2007 Jan-Feb;30(1):34-41. doi: 10.1007/s00270-005-0286-7.


Background: Sudden symptomatic occlusions of the proximal internal carotid artery (ICA) resulting in severe middle cerebral artery (MCA) ischemia and stroke are usually not accessible by rt-PA thrombolysis and the prognosis is usually very poor. Mechanical recanalization of the proximal ICA combined with intravenous and intra-arterial thrombolysis was therefore used as a rescue procedure.

Methods: Ten patients (9 men, 1 woman; mean age 56.1 years) were treated with emergency recanalization of the proximal carotid artery by using stents and/or balloon angioplasty as a rescue procedure. Three patients showed dissection, and 7 had atherothrombotic occlusions. Nine of 10 presented with an initial modified Rankin Scale (mRS) of 5, the remaining patient with mRS 4 (average NIHSS 21.4). After sonographic confirmation of ICA with associated MCA/distal ICA occlusion and bridging with rt-PA (without abciximab) an emergency angiography was performed with subsequent mechanical recanalization by percutaneous transluminal angioplasty (PTA) (n = 1) or primary stenting (n = 9) using self-expanding stents. Distal protection was used in 1 of 10 patients.

Results: Recanalization of the proximal ICA was achieved in all. At least partial recanalization of the intracerebral arteries was achieved in all, and complete recanalization in 5. In 4 of 10 patients limited hemorrhage was detected during CT controls. Major complications included 2 patients who had to undergo hemicraniectomy. One patient died from malignant infarction. At the time of discharge from the stroke unit 9 of 10 patients had improved markedly, 5 patients having an mRS of < or =2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS < or =2, and 1 a mRS of 3.

Conclusions: Primary mechanical recanalization of ICA occlusions by stent and PTA combined with fibrinolysis and/or GPIIb/IIIa-receptor antagonists seems to be feasible to improve patient outcome significantly.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Angioplasty, Balloon / methods*
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / surgery
  • Arterial Occlusive Diseases / therapy*
  • Carotid Artery, Internal / diagnostic imaging*
  • Emergency Treatment / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Angiography / methods
  • Male
  • Middle Aged
  • Postoperative Complications
  • Severity of Illness Index
  • Stents*
  • Stroke / etiology
  • Stroke / therapy*
  • Thrombolytic Therapy / methods
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome