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Title: Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke

Abstract

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 limitedmore » 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 {<=}2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS {<=}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.« less

Authors:
 [1];  [2]; ;  [1];  [3]
  1. Klinikum Ingolstadt, Department of Neurology (Germany)
  2. Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)
  3. Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany), E-mail: dierk.vorwerk@klinikum-ingolstadt.de
Publication Date:
OSTI Identifier:
21091072
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-005-0286-7; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CAROTID ARTERIES; CEREBRAL ARTERIES; FIBRINOLYSIS; HEMORRHAGE; ISCHEMIA; PATIENTS; RECEPTORS

Citation Formats

Dabitz, Rainer, Triebe, Stefan, Leppmeier, Ullrich, Ochs, Guenther, and Vorwerk, Dierk. Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke. United States: N. p., 2007. Web. doi:10.1007/S00270-005-0286-7.
Dabitz, Rainer, Triebe, Stefan, Leppmeier, Ullrich, Ochs, Guenther, & Vorwerk, Dierk. Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke. United States. doi:10.1007/S00270-005-0286-7.
Dabitz, Rainer, Triebe, Stefan, Leppmeier, Ullrich, Ochs, Guenther, and Vorwerk, Dierk. Thu . "Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke". United States. doi:10.1007/S00270-005-0286-7.
@article{osti_21091072,
title = {Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke},
author = {Dabitz, Rainer and Triebe, Stefan and Leppmeier, Ullrich and Ochs, Guenther and Vorwerk, Dierk},
abstractNote = {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 {<=}2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS {<=}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.},
doi = {10.1007/S00270-005-0286-7},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 30,
place = {United States},
year = {Thu Feb 15 00:00:00 EST 2007},
month = {Thu Feb 15 00:00:00 EST 2007}
}