Abstract TP33: Ischemic Stroke Outcomes in Medical vs Endovascular Treatment of Proximal Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yamin Shwe ◽  
Chunyan Cai ◽  
Anjail Z Sharrief ◽  
Amrou Sarrraj
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Treatment ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Small Sample ◽  
Neurological Deficits

Background: Acute ischemic stroke (AIS) due to proximal carotid artery occlusion (pCAO) can be associated with significant neurological deficits and poor outcome without timely intervention and successful reperfusion. Intravenous thrombolytics (IT) have low recanalization rates in pCAO and these patients were excluded from recent randomized controlled trials which showed superiority of endovascular therapy (EVT) over IT. Purpose: The purpose of this study is to investigate clinical outcomes in AIS due to pCAO treated with medical vs. endovascular treatment. Methods: We conducted a retrospective chart review of patients who underwent IT or EVT±IT for all types of pCAO from January 2008 to June 2015. Our primary outcome was the functional outcome at discharge measured by modified Rankin score (mRS) 0-3. The secondary outcomes were hemorrhagic transformation (HT), neurological worsening (NW), symptomatic hemorrhage (sICH) and death. Logistic regression analysis was used to compare outcomes between the two groups. Results: A total of 133 patients were included in the study. Baseline characteristics are depicted in table 1. There were no significant differences between the two groups. IV tPA was given in 56% IT vs. 72% EVT (p=0.14). While there was a shift towards better outcomes in the mRS distribution in EVT group (22% vs. 16%) as shown in Figure 1, the treatment effect did not reach significance (OR 1.71, 95% CI (0.55, 5.34), p=0.35). There was also no difference in HT (26% vs. 14%, p=0.14), or NW (26% vs. 21%, p=0.6). However, sICH was higher in EVT (3.7% vs. 0%, p=0.2). Conclusion: Our study did not show difference in discharge functional outcomes between EVT and IT in AIS with pCAO. Our results are limited by small sample size and retrospective nature. Future prospective studies randomizing patients to medical vs. endovascular treatments are warranted to guide management.

Endovascular Treatment in Patients with Persistent Internal Carotid Artery Occlusion after Intravenous Tissue Plasminogen Activator: A Clinical Effectiveness Study

2016 ◽  
Vol 42 (5-6) ◽  
pp. 387-394 ◽  
Author(s):  
Jeong-Ho Hong ◽  
Sung-Il Sohn ◽  
Jihoon Kang ◽  
Min Uk Jang ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: There has been no large-scale trial comparing endovascular treatment (add-on EVT) after intravenous tissue plasminogen activator (IV tPA) and IV tPA alone in acute ischemic stroke (AIS) caused by internal carotid artery occlusion (ICAO). We aimed at investigating the effectiveness and safety of add-on EVT after IV tPA in AIS patients with ICAO. Methods: Between March 2010 and March 2013, 3,689 consecutive ischemic stroke patients who were hospitalized within 4.5 h of onset were identified using a prospective stroke registry at 11 centers in Korea. Among them, patients with persistent ICAO after receiving IV tPA and whose 3-month modified Rankin Scale (mRS) was available were finally enrolled. A propensity score analysis with inverse-probability of treatment weighting was used to eliminate baseline imbalances between those receiving add-on EVT and IV tPA alone. Results: Among 264 patients enrolled in this study (mean age 71.4; male 56.4%; median National Institute of Health Stroke Scale score 15), 117 (44.3%) received add-on EVT. The add-on EVT group had a higher frequency of favorable outcome on the mRS ≤2 (35.0 vs. 18.4%; adjusted OR (aOR) 2.79; 95% CI 1.66-4.67) and lower mortality (17.9 vs. 35.4%; aOR 0.24; 95% CI 0.13-0.42) at 3 months, when compared to the IV tPA-alone group. Add-on EVT did not significantly increase the risk of symptomatic hemorrhage (5.1 vs. 4.1%; aOR 1.01; 95% CI 0.37-2.70). The rate of successful recanalization (thrombolysis in cerebral infarction grade ≥2b) in the add-on EVT group was 69.2%. Conclusions: Compared to an IV tPA alone, add-on EVT can improve clinical outcomes in patients with symptomatic ICAO within 4.5 h of onset without a significant increase of symptomatic hemorrhage.

scholarly journals Recanalization of Extracranial Internal Carotid Artery Occlusion after i.v. Thrombolysis for Acute Ischemic Stroke

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e55318 ◽  
Author(s):  
Raimund Pechlaner ◽  
Michael Knoflach ◽  
Benjamin Matosevic ◽  
Michael Ruecker ◽  
Christoph Schmidauer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Extracranial Internal Carotid Artery

Abstract WP33: Reperfusion Therapy in Carotid Artery Occlusion with Collaterals Through the Circle of Willis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong Hwan Ahn ◽  
In Sung Choo ◽  
Hyun Gu Kang ◽  
Ji Yeon Jung ◽  
Sang Woo Ha
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Carotid Occlusion ◽  
Large Artery ◽  
Clinical Worsening

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

High-Flow Extracranial-to-Intracranial Excimer Laser–Assisted Nonocclusive Anastomosis Bypass for Symptomatic Carotid Artery Occlusion

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1687-1694 ◽  
Author(s):  
Tristan P.C. van Doormaal ◽  
Catharina J.M. Klijn ◽  
Perry T.C. van Doormaal ◽  
L. Jaap Kappelle ◽  
Luca Regli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Bypass Surgery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
High Flow ◽  
Transient Ischemic Attacks ◽  
Mean Flow ◽  
Symptomatic Carotid

Abstract BACKGROUND: A high-flow bypass is theoretically more effective than a conventional low-flow bypass in preventing strokes in patients with symptomatic carotid artery occlusion and a compromised hemodynamic state of the brain. OBJECTIVE: To study the results of excimer laser-assisted nonocclusive anastomosis (ELANA) high-flow extracranial-to-intracranial (EC-IC) bypass surgery in these patients. METHODS: Between August 1998 and May 2008, 24 patients underwent ELANA EC-IC bypass surgery because of transient ischemic attacks or minor ischemic stroke associated with carotid artery occlusion. We retrospectively collected information. Follow-up data were updated by structured telephone interviews between May and September 2008. RESULTS: In all patients, the ELANA EC-IC bypass was patent at the end of surgery with a mean flow of 106 ± 41 mL/min. Within 30 days after the operation, 22 patients (92%) had no major complication, whereas 2 patients (8%) had a fatal intracerebral hemorrhage. During follow-up of a mean 4.4 ± 2.4 years, the bypass remained patent in 18 of the 22 surviving patients (82%) with a mean flow of 141 ± 59 mL/min. All patients with a patent bypass remained free of transient ischemic attacks and ischemic stroke. In 4 patients, the bypass occluded, accompanied by ipsilateral transient ischemic attacks in 2 patients, ipsilateral ischemic stroke in 1 patient, and contralateral ischemic stroke in another patient. CONCLUSION: ELANA EC-IC bypass surgery in patients with carotid artery occlusion is technically feasible and results in cessation of ongoing transient ischemic attacks and minor ischemic strokes, but carries a risk of postoperative hemorrhage.

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