Endovascular treatment of carotid artery occlusion in progressive stroke syndromes: technical note

Neurosurgery. 1998 Jan;42(1):186-91; discussion 191-3. doi: 10.1097/00006123-199801000-00042.

Abstract

Objective and importance: We describe two patients, with progressing neurological deficits, who showed improvement after revascularization of their carotid arteries using stents.

Clinical presentation: One patient presented clinically with the symptoms of a middle cerebral artery territory stroke. Angiography demonstrated total occlusion of the right internal carotid artery (ICA), with evidence of clot from the origin of the ICA to the middle cerebral artery trifurcation. The second patient presented with bilateral ICA occlusions and evidence of a progressing left hemispheric deficit; she was receiving therapeutic levels of heparin at the time of deterioration of her condition.

Intervention: Thrombolysis and stenting successfully recanalized the occluded vessels, and the deficits of the first patient were reversed. With the second patient, a dissected carotid loop was encountered. Straightening of the loop with a wire and stenting of the carotid artery using two stents allowed revascularization of the left hemisphere and resolution of most of the deficits of this patient.

Conclusion: This report demonstrates the technical feasibility of placing stents in high-risk patients with carotid artery occlusions from either dissection or atherosclerosis. Both patients sustained much smaller infarctions than would have been expected if the carotid artery territory had been infarcted. We report on the technical feasibility of reopening acutely closed ICAs by using endovascular methods.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / surgery*
  • Arterial Occlusive Diseases / therapy
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / surgery*
  • Carotid Artery Diseases / therapy
  • Cerebral Angiography
  • Cerebrovascular Disorders / diagnostic imaging
  • Cerebrovascular Disorders / surgery*
  • Female
  • Humans
  • Male
  • Splints*
  • Syndrome
  • Thrombolytic Therapy
  • Tomography, X-Ray Computed