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CardioVascular and Interventional Radiology

, Volume 30, Issue 1, pp 34–41 | Cite as

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

  • Rainer Dabitz
  • Stefan Triebe
  • Ullrich Leppmeier
  • Günther Ochs
  • Dierk VorwerkEmail author
Article

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 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.

Keywords

Abciximab Acute obstruction Acute stroke Carotid artery, internal Carotid artery, occlusion  Dissection, carotid artery Stent angioplasty Tandem obstruction Thrombolysis, intra-arterial Thrombolysis, local 

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Rainer Dabitz
    • 1
  • Stefan Triebe
    • 2
  • Ullrich Leppmeier
    • 1
  • Günther Ochs
    • 1
  • Dierk Vorwerk
    • 2
    Email author
  1. 1.Department of NeurologyKlinikum IngolstadtIngolstadtGermany
  2. 2.Department of Diagnostic and Interventional RadiologyKlinikum IngolstadtIngolstadtGermany

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