scholarly journals Emergency Cervical Internal Carotid Artery Stenting in Combination with Intracranial Thrombectomy in Acute Stroke

2013 ◽  
Vol 35 (4) ◽  
pp. 741-746 ◽  
Author(s):  
S. Stampfl ◽  
P. A. Ringleb ◽  
M. Mohlenbruch ◽  
C. Hametner ◽  
C. Herweh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Stroke ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Cervical Internal Carotid Artery

scholarly journals Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first?

2017 ◽  
Vol 42 (4) ◽  
pp. E16 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Gary B. Rajah ◽  
Hakeem J. Shakir ◽  
Hussain Shallwani ◽  
Sirin Gandhi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Clinical Outcome ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
National Institutes Of Health ◽  
Present Treatment ◽  
Tandem Occlusion ◽  
Cervical Internal Carotid Artery

OBJECTIVE Acute tandem occlusions of the cervical internal carotid artery and an intracranial large vessel present treatment challenges. Controversy exists regarding which lesion should be addressed first. The authors sought to evaluate the endovascular approach for revascularization of these lesions at Gates Vascular Institute. METHODS The authors performed a retrospective review of a prospectively maintained, single-institution database. They analyzed demographic, procedural, radiological, and clinical outcome data for patients who underwent endovascular treatment for tandem occlusions. A modified Rankin Scale (mRS) score ≤ 2 was defined as a favorable clinical outcome. RESULTS Forty-five patients were identified for inclusion in the study. The average age of these patients was 64 years; the mean National Institutes of Health Stroke Scale score at presentation was 14.4. Fifteen patients received intravenous thrombolysis before undergoing endovascular treatment. Thirty-seven (82%) of the 45 proximal cervical internal carotid artery occlusions were atherothrombotic in nature. Thirty-eight patients underwent a proximal-to-distal approach with carotid artery stenting first, followed by intracranial thrombectomy, whereas 7 patients underwent a distal-to-proximal approach (that is, intracranial thrombectomy was performed first). Thirty-seven (82%) procedures were completed with local anesthesia. For intracranial thrombectomy procedures, aspiration alone was used in 15 cases, stent retrieval alone was used in 5, and a combination of aspiration and stent-retriever thrombectomy was used in the remaining 25. The average time to revascularization was 81 minutes. Successful recanalization (thrombolysis in cerebral infarction Grade 2b/3) was achieved in 39 (87%) patients. Mean National Institutes of Health Stroke Scale scores were 9.3 immediately postprocedure (p < 0.05) (n = 31), 5.1 at discharge (p < 0.05) (n = 31), and 3.6 at 3 months (p < 0.05) (n = 30). There were 5 in-hospital deaths (11%); and 2 patients (4.4%) had symptomatic intracranial hemorrhage within 24 hours postprocedure. Favorable outcomes (mRS score ≤ 2) were achieved at 3 months in 22 (73.3%) of 30 patients available for follow-up, with an mRS score of 3 for 7 of 30 (23%) patients. CONCLUSIONS Tandem occlusions present treatment challenges, but high recanalization rates were possible in the present series using acute carotid artery stenting and mechanical thrombectomy concurrently. Proximal-to-distal and aspiration approaches were most commonly used because they were safe, efficacious, and feasible. Further study in the setting of a randomized controlled trial is needed to determine the best sequence for the treatment approach and the best technology for tandem occlusion.

scholarly journals Treatment of idiopathic cervical internal carotid artery vasospasms with carotid artery stenting: a report of 2 cases

2013 ◽  
Vol 7 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Michio FUJIMOTO ◽  
Hiroshi ITOKAWA ◽  
Masao MORIYA ◽  
Noriyoshi OKAMOTO ◽  
Yoshiyuki TOMITA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Cervical Internal Carotid Artery

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

2008 ◽  
Vol 48 (2) ◽  
pp. 49-56 ◽  
Author(s):  
Naoko MIYAMOTO ◽  
Isao NAITO ◽  
Shin TAKATAMA ◽  
Tatsuya SHIMIZU ◽  
Tomoyuki IWAI ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Stroke ◽  
Internal Carotid ◽  
Cervical Internal Carotid Artery

scholarly journals Emergent carotid artery stenting in patients with acute ischemic stroke due to cervical internal carotid artery steno-occlusive lesion: Comparison of tandem intracranial occlusion and isolated cervical internal carotid artery occlusion

2020 ◽  
Vol 26 (4) ◽  
pp. 425-432
Author(s):  
Sung E Park ◽  
Dae S Choi ◽  
Hye J Baek ◽  
Kyeong H Ryu ◽  
Ji Y Ha ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Occlusive Lesion ◽  
Cervical Internal Carotid Artery

Purpose Acute ischemic strokes caused by steno-occlusive lesion of the cervical internal carotid artery are associated with poor clinical outcome. We evaluated the clinical efficacy of emergent carotid artery stenting for the management of these lesions. We compared the clinical outcomes regarding the intracranial lesion, namely tandem occlusions versus isolated cervical internal carotid artery occlusion. Materials and methods We retrospectively reviewed patients with acute ischemic stroke who underwent carotid artery stenting for cervical internal carotid artery steno-occlusive lesion between 2011 and 2018. After dividing the patients into two groups according to the presence or absence of intracranial lesions (tandem group and isolated cervical group), we analyzed demographic data, angiographic findings, and clinical outcomes. A modified Rankin Scale score ≤2 was defined as a favorable clinical outcome. Results Of 75 patients, 46 patients (61.3%) had tandem lesions, and the remaining 29 had only cervical internal carotid artery steno-occlusive lesion. Successful stenting was performed in all patients with favorable clinical outcomes (64.0%). Successful reperfusion score (thrombolysis in cerebral infarction ≥2 b) was 84.0%; tandem group (76.1%) versus isolated cervical group (96.6%) of cases. Mean modified Rankin Scale score at 90-days was 2.09. The rate of favorable clinical outcome showed no statistically significant difference between the two groups ( p = 0.454). Conclusions Endovascular treatment in patients with acute ischemic stroke due to cervical internal carotid artery steno-occlusive lesion is a technically feasible and clinically effective intervention regardless of intracranial occlusion. Therefore, we recommend endovascular treatment regardless of the presence of concomitant intracranial artery occlusion for patients with acute ischemic stroke caused by cervical internal carotid artery steno-occlusive lesion.

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