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Endovascular treatment in patients with acute ischemic stroke and apparent occlusion of the extracranial internal carotid artery on CTA
  1. Hanneke M Duijsens1,
  2. Fianne Spaander2,
  3. Lukas C van Dijk1,
  4. Frank E Treurniet1,
  5. Rudolf W Keunen2,
  6. Arne Mosch2,
  7. Charles B Majoie3,
  8. Hans van Overhagen1
  1. 1Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
  2. 2Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
  3. 3Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to H Duijsens, Department of Radiology, HagaZiekenhuis loc. Leyweg, Leyweg 275, The Hague 2545 CH, The Netherlands; hmhduijsens{at}gmail.com

Abstract

Background Intra-arterial treatment is gaining importance in acute ischemic stroke, but its role in patients with apparent occlusion of the extracranial internal carotid artery (ICA) on computed tomographic angiography (CTA) is inconclusive.

Objective To review retrospectively the results of intra-arterial treatment in patients with stroke and apparent extracranial ICA occlusion.

Methods In more than 3000 patients with stroke admitted to our institution during 2008–2013, and the subgroup with suboptimal results after intravenous thrombolysis (IVT), CTA showed the absence of contrast in the extracranial ICA in 16 patients. Angiography showed true occlusion of the extracranial ICA in 10 and pseudo-occlusion in 6 patients. Treatment was considered technically successful when Thrombolysis in Cerebral Infarction scale (TICI) scores improved to 2 or 3 and clinically successful when the National Institutes of Health Stroke Scale (NIHSS) improved by at least 10 points or a NIHSS score of 0 or 1 was found at discharge.

Results Recanalization was achieved in 5 of 6 patients with pseudo-occlusions and in 6 of 10 patients with true occlusion of the extracranial ICA. Favorable clinical outcomes were seen in 3 of 6 patients with pseudo-occlusions and in 4 of 10 patients with true occlusions. Four patients died, and in these patients infarction of >15% of the affected hemisphere had been seen on admission CT.

Conclusions In cases of acute stroke and apparent occlusion of the extracranial ICA, intra-arterial treatment should be considered, especially when IVT fails and <15% of the hemisphere is infarcted on CT. Endovascular treatment may be beneficial especially in pseudo-occlusions but also in true occlusions of the extracranial ICA.

  • Stroke
  • CT Angiography
  • Stent
  • Thrombolysis
  • Thrombectomy

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