Emergency Carotid Artery Stenting in Acute Ischemic Stroke

Abstract

Background and Purpose: Stroke caused by acute occlusion of the extracranial internal carotid artery (ICA) is associated with a significant level of morbidity and mortality. The purpose of this study is to demonstrate the technical success of recanalization with carotid artery stenting (CAS) for an acute ICA occlusion as well as the benefit in clinical outcome. Methods: We retrospectively reviewed 27 patients that were treated with CAS for an atherosclerotic extracranial ICA occlusion within 6 hours of symptom onset. In 23 patients there was an additional occlusion; at the level of the terminal segment of the ICA (5 patients) and at the level of the middle cerebral artery (18 patients). To treat the intracranial occlusion intraarterial thrombolysis or mechanical recanalization was performed. Recanalization results were assessed by follow-up angiography immediately after the procedure. The neurological status was evaluated before and after the treatment with a follow up of up to 90 days using the NIHSS and mRS. Results: Successful revascularization of extracranial ICA with acute stent implantation was achieved in 26 patients (96%). There was no acute stent thrombosis. After successful recanalization of the origin of the ICA the intracranial recanalization with TICI 2b/3 flow was achieved in 16 of the 23 patients (69.5%). The overall recanalization rate (extracranial and intracranial) was 19/27 (63%). 13 patients (48%) showed a mRS score of 0-2 at 90 days. Mortality was 11%. Conclusion: CAS in acute extracranial ICA occlusion with severe stroke symptoms is feasible, safe and useful within the first 6 hours.