Abstract 1122‐000168: Hyperacute Stenting and Angioplasty for Isolated Non‐tandem Cervical ICA Strokes within the First 48 Hours
Introduction : Acute stroke that involves complete and isolated occlusion of extracranial cervical ICA segment with no intracranial clot burden account for a minority of stroke cases. Since endarterectomy is not recommended in the hyperacute phase (first 48 hours), management of these strokes includes administration of IV‐tPA as part of standard medical therapy. This makes endovascular intervention with acute carotid artery stenting (CAS) with or without balloon angioplasty a viable treatment option during the hyperacute phase of the disease. We aim to present our two‐decade long experience of endovascular management of complete and isolated cervical ICA occlusive strokes in the hyperacute phase, and attempt to evaluate the clinical efficacy and safety of this treatment modality. Methods : A prospectively maintained database was retrospectively searched for patients who presented from Jan 2000 – Dec 2020 with acute cervical ICA stroke confirmed on angiography. Only patients who had 100% occlusion of cervical ICA segment and who underwent acute CAS within the first 48 hours of symptom onset were included. Patients who had an intracranial or tandem lesion or those with <100% EC‐ICA stenosis were excluded. Information on demographics, co‐morbidities, procedural details, and complications was recorded. Rate of adequate revascularization and follow up were also recorded. Results : A total of 46 patients with acute cervical ICA occlusive stroke were included in the study. Mean age was 68.9 years, and 32 (69.6%) were male. Median NIH Stroke Scale at admission was 8 (IQR 7) with a perfusion deficit seen in 78.3% of cases. IV‐tPA was administered in 41.3% of cases with median time from symptom onset to puncture 14.4 hours. Stenting was performed in all patients with pre‐ and/or post‐angioplasty done in 78.3% of cases. Successful recanalization was achieved in 82.6% cases. One patient (2.2%) suffered a symptomatic intracerebral hemorrhage (sICH) post‐procedure. Outcome measures were reported as stable or improved NIHSS at discharge in 86.9% of cases, with good outcome (functional independence at 90‐day‐mRS <2) at 78.3% and a mortality rate of 6.5%. Conclusions : Emergent stenting and angioplasty for acute cervical ICA occlusive strokes within the first 48 hours (hyperacute phase) can be performed successfully with good clinical outcomes and an impressive rate of recanalization.