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Abstract
Introduction The entity of internal carotid artery (ICA) “pseudo-occlusion,” where an occlusion of the intracranial ICA appears as an occlusion of the extracranial cervical ICA on computed-tomography angiography (CTA) or digital subtraction angiography (DSA) is more common than previously thought. We aim to accurately describe and analyze this entity for the benefit of the treating interventionalist.
Methods This was a retrospective review of a prospectively collected thrombectomy database between February 2011-January 2016. Over 900 patients were treated within the study period, and we subselected the 46 patients who had an occlusion of the intracranial ICA without evidence of a tandem occlusion in the cervical ICA. These patients’ angiograms were analyzed for the presence of cervical ICA “pseudo-occlusion.” Details of their demographics, medical history, thrombectomy procedure, and outcome were then analyzed.
Results The mean age for the total population was 62.3 (Range: 31–91). There was an exact split between sexes in the total population. Cervical ICA “pseudo-occlusion” was found in 21 of the 46 patients (46%) on CTA. 17 (81%) of these patients had “pseudo-occlusion” of the proximal cervical ICA and 4 had “pseudo-occlusion” of the mid-cervical ICA. 15 (71%) of these patients continued to have “pseudo-occlusion” on DSA during their thrombectomy procedure.
When comparing the two groups, 48% of the“pseudo-occlusion” group and 52% of the non-“pseudo-occlusion” group were male. The mean age of the “pseudo-occlusion” cohort was 64.8 versus 60.1 in the non-“pseudo-occlusion” cohort. 38% of the “pseudo-occlusion” patients and 40% of the non-“pseudo-occlusion” patients received IV TPA.
The rates of mTICI 2 b/3 reperfusion were 81% in the “pseudo-occlusion cohort” versus 100% in the non-“pseudo-occlusion” cohort. (p < 0.05). The mean procedure length was 89.45 minutes in the “pseudo-occlusion” group
versus 62.16 minutes in the non-“pseudo-occlusion” group (p = 0.07). The rate of ECASS Parenchymal Hematoma Type 2 was 4.8% in the “pseudo-occlusion” group versus 4% in the non-“pseudo-occlusion” group. 90 day follow-up mRS was available in 20 “pseudo-occlusion” patients and 19 non“pseudo-occlusion” patients. The rate of 90 day mRS 0–2 was 35% in the “pseudo-occlusion” group and 63% in the non-“pseudo-occlusion” group. The 90 day mortality rate was 25% in the “pseudo-occlusion” group and 21% in the non-“pseudo-occlusion” group.
Conclusions Carotid “pseudo-occlusion” is a common entity in the thrombectomy population, and its presence is associated with increased procedure time and decreased rates of reperfusion.
Disclosures J. Grossberg: None. F. Cardoso: None. L. Rebello: None. D. Haussen: None. M. Frankel: None. R. Nogueira: None.
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