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  • Outcomes of Carotid Artery Angioplasty and Stenting in Patients after Treatment of Acute Ischemic Stroke

    Final Number:

    Peter J. Morone MD; J D. Mocco MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Internal carotid artery (ICA) angioplasty and stenting is a treatment modality for patients with acute stroke that is associated with carotid artery occlusion. Here we investigate the use of this combined technique and evaluate the results and outcomes of carotid artery recanalization in patients presenting with acute ischemic stroke.

    Methods: Over six months, five patients with acute ischemic stroke associated with cervical ICA occlusion underwent combined ICA angioplasty and stenting with or without intracranial mechanical thrombectomy. A retrospective review was completed and clinical variables were evaluated. Thrombolysis in cerebral ischemia (TICI) score was used to define the degree of recanalization, and a favorable outcome was defined as a Modified Rankin Scale (mRS) score of 0–3 at 90 days.

    Results: The mean patient age was 60.2 (range 49-77) and the mean presenting National Institute of Health Stroke Scale was 17.8 (range 16-19). Out of all patients, four had complete occlusion of the left ICA and one had complete occlusion of the right ICA. In four patients there was concomitant intracranial occlusion. The time from symptom onset to endovascular intervention was less than or equal to 3 hours in three patients, 10 hours in one patient and unknown in the other patient. Internal carotid angioplasty with stenting was completed in all patients. A TICI score greater than IIb was achieved in 100% of patients and grade III was achieved in 60% of patients. The 90 day mRS was 0-2 in 40% of patients and 0-3 in 60% of patients.

    Conclusions: Clinical outcomes suggest that carotid artery angioplasty and stenting is a useful and reasonable technique for carotid artery recanalization in patients undergoing treatment for an acute ischemic stroke. Further studies need to be completed to assess the overall safety and efficacy of this combined technique for use of treatment in acute ischemic stroke.

    Patient Care: As different endovascular treatments for acute ischemic stroke are rapidly developing, it is important to understand the indications, procedural risks/benefits and clinical outcomes of these modalities. Carotid angioplasty and stenting represents a reasonable option for treatment of acute ischemic stroke. By further understanding this endovascular technique, other phsycisians will be able to treat acute ischemic stroke with increased safety and efficacy.

    Learning Objectives: By conclusion of this session, participants should be able to describe the importance of carotid artery angioplasty and stenting as a treatment for acute ischemic stroke. They should also be able to identify the clinical indications and risks/benefits of performing this procedure. Finally, participants should be able to discuss the future directions of this procedure and other treatment modalities used in treating acute ischemic stroke.

    References: Lee, J. S., Hong, J. M., Lee, S.-J., Joo, I. S., Lim, Y. C., & Kim, S. Y. (2013). The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta neurochirurgica, 155(4), 635–641. Mantese, V. A., Timaran, C. H., Chiu, D., Begg, R. J., Brott, T. G., CREST Investigators. (2010). The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke, 41(10 Suppl), S31–4. Singh, J., & Nguyen, T. N. (2012). Endovascular and neurosurgical management of acute ischemic stroke. Emergency medicine clinics of North America, 30(3), 695–7[1]12.

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