Publication year: 2012
Source:World Neurosurgery
Richard T. Dalyai, Nohra Chalouhi, Saurabh Singhal, Pascal Jabbour, L. Fernando Gonzalez, Aaron S. Dumont, Robert Rosenwasser, George Ghobrial, Stavropoula I. Tjoumakaris
Objective Carotid artery occlusions traditionally have extremely poor outcomes with intravenous tissue plasminogen activator (IVtPA) treatment or emergent thromboendarterectomy. We retrospectively reviewed our institutional experience with acute carotid occlusions utilizing internal carotid artery (ICA) endovascular thrombolysis and stent placement. Methods We studied the radiographic and clinical characteristics of 17 patients with an acute cervical ICA occlusion treated with stent-assisted endovascular thrombolysis. Clinical outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS), which were obtained upon admission and discharge. Inclusion criteria were an NIHSS of at least 6 and presence of significant penumbra on CT Perfusion (CTP). Morbidity and mortality data were collected and analyzed. Results 17 candidates met our inclusion criteria, 16 (94%) of which had successful immediate recanalization of the internal carotid artery. Upon admission, the mean NIHSS was 16.5 and the mean modified Rankin score (mRS) was 4.8. The mean NIHSS improved to 6.9 upon discharge, with a mean mRS of 2.88. Eight patients (47%) recovered ambulatory function upon discharge. The overall mortality rate of our series was 17%. Conclusions In the setting of acute ischemic stroke, emergent carotid artery thrombolysis and stenting is a promising treatment for acute carotid occlusions with excellent recanalization rates and favorable clinical outcomes.
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