Acta Neurochirurgica

, Volume 155, Issue 6, pp 1115–1123

Endovascular intervention for acute cervical carotid artery occlusion

  • Noriaki Matsubara
  • Shigeru Miyachi
  • Nobuhiro Tsukamoto
  • Takao Kojima
  • Takashi Izumi
  • Kenichi Haraguchi
  • Takumi Asai
  • Takashi Yamanouchi
  • Keisuke Ota
  • Toshihiko Wakabayashi
Clinical Article - Vascular

DOI: 10.1007/s00701-013-1697-x

Cite this article as:
Matsubara, N., Miyachi, S., Tsukamoto, N. et al. Acta Neurochir (2013) 155: 1115. doi:10.1007/s00701-013-1697-x

Abstract

Background

Acute cervical carotid artery occlusion presents with a severe neurological deficit and is associated with unfavorable outcomes. In this study, the authors report their experience with patients having had acute ischemic stroke due to cervical carotid occlusion, who underwent endovascular intervention.

Method

Sixteen acute cervical carotid occlusion patients (15 males and 1 female; mean age 67.7 years) were treated by endovascularly between January 2009 and November 2012. Clinical, procedural, and angiographic data were retrospectively evaluated. Successful intracranial recanalization was based on thrombolysis in cerebral infarction score of 2B-3. A favorable outcome was defined as a modified Rankin Scale score of 0–2 at 90 days.

Findings

The average score of National Institutes of Health Stroke Scale before treatment was 15.9. Ten of 16 patients (63 %) were associated with intracranial tandem occlusion. Ten (63 %) cases were caused by atherosclerotic, 4 (25 %) by atrial fibrillation (AF), and 2 (13 %) by dissection. Thirteen of 16 (81 %) achieved successful cervical recanalization and 7 of 16 (44 %) patients obtained sufficient cervical and intracranial perfusion. As a result, 5 of 16 (31 %) patients demonstrated favorable outcomes. Five of seven patients (71 %) with successful cervical and intracranial recanalization presented favorable outcomes. In contrast, none of the patients without cervical or intracranial recanalization presented favorable outcomes. Three of 6 (50 %) patients initially without intracranial occlusion showed favorable outcomes, but only 2 of 10 (20 %) patients associated with intracranial occlusion had favorable outcomes. On the aspect of etiology, in atherosclerotic cases, 4 of 10 (40 %) showed favorable outcomes. However, all four AF cases deteriorated into poor outcomes.

Conclusions

This study demonstrated the feasibility of endovascular intervention for acute cervical carotid artery occlusion. Although treatment for tandem occlusion and AF cases is an issue that should be resolved, intervention must be encouraged. Successful cervical and intracranial revascularization will be essential for favorable outcomes.

Keywords

Cervical carotid artery occlusion Endovascular intervention Acute stroke Carotid artery stenting Recanalization 

Abbreviations

AF

Atrial fibrillation

CAS

Carotid artery stenting

CCA

Common carotid artery

ECA

External carotid artery

ICA

Internal carotid artery

MCA

Middle cerebral artery

mRS

modified Rankin Scale

NIHSS

National Institute of Health Stroke Scale

PTA

Percutaneous transluminal angioplasty

TICI

Thrombolysis in cerebral infarction

t-PA

Tissue plasminogen activator

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Noriaki Matsubara
    • 1
  • Shigeru Miyachi
    • 1
  • Nobuhiro Tsukamoto
    • 2
  • Takao Kojima
    • 3
  • Takashi Izumi
    • 1
  • Kenichi Haraguchi
    • 1
  • Takumi Asai
    • 1
  • Takashi Yamanouchi
    • 1
  • Keisuke Ota
    • 1
  • Toshihiko Wakabayashi
    • 1
  1. 1.Department of NeurosurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of NeurosurgeryHekinan Municipal HospitalHekinanJapan
  3. 3.Department of NeurosurgeryJapanese Red Cross Nagoya Daini HospitalNagoyaJapan

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