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Partial recanalization of concomitant internal carotid–middle cerebral arterial occlusions promotes distal recanalization of residual thrombus within 24 h
  1. Y Loh1,2,3,
  2. D S Liebeskind4,
  3. Z S Shi2,
  4. R Jahan2,
  5. N R Gonzalez1,2,
  6. S Tateshima2,
  7. P M Vespa1,
  8. S Starkman4,
  9. J L Saver4,
  10. F Viñuela2,
  11. G R Duckwiler2
  1. 1Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  2. 2Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  3. 3Neurovascular Service, Department of Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
  4. 4Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Correspondence to Dr Y Loh, Neurovascular Service, Department of Medicine, Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA; yincer{at}yahoo.com

Abstract

Objectives Acute, simultaneous, concomitant internal carotid artery (ICA) and middle cerebral arteries (MCA) occlusions almost invariably lead to significant neurological disability if left untreated. Endovascular therapy is frequently the method of treatment in such situations but there remains a chance of incomplete recanalization. Successful recanalization of the proximal aspect of the occlusion may allow for endogenous thrombolysis and facilitate further endogenous recanalization of any residual MCA occlusion.

Methods Consecutive patients with acute ischemic stroke undergoing endovascular therapy for tandem extracranial ICA–MCA or contiguous intracranial ICA–MCA occlusions were retrospectively analyzed. Rates of facilitated endogenous recanalization at 24 h (FER24) were compared by imaging within the immediate post-intervention 5–24 h period in those with proximal recanalization and in those without.

Results 17 patients were included in the analysis. 12 patients had good initial proximal recanalization but a residual partial or total occlusion of the MCA while five patients failed any recanalization. Seven patients (58.3%) in the first group and none in the second had FER24 on interval imaging after intervention (p=0.04). The probability of death and disability at discharge was less in patients with FER24 than those without (p=0.05).

Conclusions More than half of all patients who present with both ICA and MCA occlusions who are only partially recanalized will undergo facilitated endogenous recanalization within the subsequent 24 h following intervention.

  • Hemorrhage
  • Stroke
  • Angioplasty
  • Stent
  • Thrombectomy

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Footnotes

  • Disclaimer The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense or the United States Government.

  • Competing interests All authors are or have been employees of the University of California, which holds several patents on retriever devices for stroke. GRD is a Scientific Advisor for and shareholder in Concentric Medical, Inc. DSL is a consultant for Concentric Medical. SS has received grant funding for clinical trials from Concentric Medical and Genentech Inc. JLS is a scientific consultant for CoAxia, Concentric Medical, Talecris, Ferrer, AGA Medical, BrainsGate, PhotoThera and Cygnis; has received lecture honoraria from Ferrer and Boehringer Ingelheim; received support for clinical trials from Concentric Medical; and is a site investigator in multicenter trials sponsored by AGA Medical and the NIH for which the UC Regents received payments based on the number of subjects enrolled.

  • Ethics approval The study was approved by the local institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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