Document Detail


Emergent Endovascular Recanalization for Cervical Internal Carotid Artery Occlusion in Patients Presenting with Acute Stroke.
MedLine Citation:
PMID:  21499144     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Acute proximal (cervical) internal carotid artery (ICA) occlusion may cause ischemia of an entire hemisphere or no ischemia at all, depending on the presence of intracranial collaterals. OBJECTIVE:: To retrospectively analyze the clinical results for emergent endovascular carotid recanalization in patients with acute proximal (cervical) ICA occlusion. Predictors of recanalization and clinical, neurological and functional outcome are assessed. METHODS:: Emergent endovascular revascularization was attempted in 22 patients presenting with acute stroke secondary to complete cervical ICA occlusion. Patients with pseudo-occlusion were excluded. Recanalization was assessed using the Thrombolysis in Myocardial Ischemia (TIMI) system: grade 0 (no flow) to grade 3 (normal flow). RESULTS:: The median age of the patients was 65 years; mean admission National Institutes of Health Stroke Scale (NIHSS) score was 14. Recanalization (TIMI 2/3) occurred in 17 patients (77.3%). Ten patients (45.5%) demonstrated significant clinical improvement during hospitalization (NIHSS improved ≥4 points). Fifty percent of patients had good outcomes (modified Rankin Scale [mRS] ≤2) after a median follow-up time of 3 months. Patient age <70 years and successful recanalization (TIMI 2/3) predicted a good outcome (P≤0.01). Presence of atrial fibrillation, admission NIHSS score ≥20, and complete ICA occlusion at all levels (cervical, petrocavernous, and intracranial) were associated with poor outcomes (P≤0.05). Patients with complete cervical ICA occlusion but partial distal preservation of the vessel were most likely to benefit from the intervention (recanalization in 88.2%; good outcome in 64.7%). CONCLUSION:: Attempts at emergent endovascular carotid recanalization for acute stroke are encouraged, particularly in younger patients with partial distal preservation of the ICA.
Authors:
Erik F Hauck; Sabareesh K Natarajan; Hajime Ohta; Christopher S Ogilvy; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY; and Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo NY; 2Departments of Neurosurgery & Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY; and Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo NY; 3Neurosurgical Service, Massachusetts General Hospital, Boston MA; Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY; and Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo NY.
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