Background Re-establishing cerebral blood flow in a timely fashion during an acute stroke has been shown to be efficacious in improving patient outcomes. Complete occlusion of the internal carotid artery (ICA) in progressive stroke patients would be expected to bring about devastating neurological sequelae and probably not be compatible with survival unless it could be treated. We retrospectively analyzed the feasibility, safety and effectiveness of the urgent recanalization using stents for acute ICA occlusion in the progressive stroke syndromes.
Methods Between January 2008 and December 2009, urgent recanalization using stents for acute ICA occlusion was performed in 21 progressive stroke patients. The group of patients comprised 16 men and five women, aged 52–83 years (mean age 68.8 years). The occlusion segments of ICA were extracranial in nine patients and intracranial in 12 patients. A 0.014 inch microwire was placed into the distal ICA or middle cerebral artery, crossing the occluded segment. The stent was then advanced over the microwire and deployed in the lesion.
Results We achieved successfully complete recanalization using stents in 19 of 21 patients (90.1%). We could not advance the stent delivery system into the lesion in two patients because of the vascular tortuousness. During the procedure, ICA dissection occurred in two patients (9.5%) and was treated with additional stent placement. There was no symptomatic thromboembolic complication. Fifteen of 19 patients (78.9%) showed the stable or improved neurologic signs and favorable clinical outcomes. Four patients (21.1%) showed brain edema and aggravating neurologic signs and two of them (10.5%) expired due to massive brain edema and herniation.
Conclusion Urgent recanalization using stents for acute ICA occlusion may salvage the vessel and promise better clinical outcome in the progressive stroke patients. Endovascular recanalization for ICA occlusion is feasible with acceptable early clinical result.
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Competing interests None.
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