Carotid Artery Stenting in Acute Stroke

Study Questions:

What is the technical success and benefit of carotid artery stenting in acute extracranial internal carotid artery (ICA) occlusion?

Methods:

The authors reported their experience with 22 patients with acute atherosclerotic extracranial ICA occlusion who were treated within 6 hours of stroke symptom onset using carotid stenting. In 18 patients, there was an additional intracranial occlusion at the level of the terminal segment of the ICA (four patients) and at the level of the middle cerebral artery (14 patients). Intracranial occlusions were either treated with the Penumbra system or the Solitaire stent–based recanalization system, or a combination of mechanical recanalization and intra-arterial thrombolysis.

Results:

Successful revascularization of extracranial ICA was achieved in 21 of the 22 patients. There was no acute stent thrombosis. After successful recanalization of the origin of the ICA, the intracranial recanalization with Thrombolysis In Myocardial Infarction 2/3 flow was achieved in 11 of the 18 patients (61%). The overall recanalization rate (extracranial and intracranial) was 63% (14 of 22 patients ). The mortality rate was 13.6% at 90 days with nine patients (41%) having a Modified Rankin Scale score of ≤2 at 90 days.

Conclusions:

An endovascular approach can be successfully applied to patients presenting with atherosclerotic extracranial ICA occlusion within the first 6 hours after symptom onset.

Perspective:

Stroke resulting from acute occlusion of the extracranial carotid artery is associated with high morbidity and mortality even among patients treated with thrombolytic therapy. The results of this and similar small series suggest a favorable outcome with an endovascular approach when performed in experienced centers (Jovin et al., Stroke 2005;36:2426-30). These studies support an emerging role for endovascular treatment for management of these devastating strokes.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging

Keywords: Middle Cerebral Artery, Thrombolytic Therapy, Myocardial Infarction, Stroke, Coronary Angiography, Thrombosis, Carotid Artery Diseases, Carotid Stenosis, Stents


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