RT Journal Article SR Electronic T1 Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP neurintsurg-2018-013810 DO 10.1136/neurintsurg-2018-013810 A1 Ashutosh Jadhav A1 David Panczykowski A1 Mouhammad Jumaa A1 Amin Aghaebrahim A1 Manasa Ranginani A1 Felix Nguyen A1 Shashvat M Desai A1 Ramesh Grandhi A1 Andrew Ducruet A1 Bradley A Gross A1 Brian Thomas Jankowitz A1 Tudor G Jovin YR 2018 UL http://jnis.bmj.com/content/early/2018/04/28/neurintsurg-2018-013810.abstract AB Introduction Symptomatic internal carotid artery occlusion (ICAO) can lead to neurologic decline, recurrent stroke, and mortality.Objective We sought to evaluate the safety and feasibility of endovascular revascularization for ICAO without tandem intracranial large vessel occlusion (LVO).Design, setting, and participants This is a retrospective cohort analysis of all patients presenting to a single academic center with ischemic stroke and ipsilateral cervical ICAO from November 2003 through April 2016. Patients were excluded if pre-procedural angiography demonstrated tandem LVO or if patients were known to have chronic ICAO.Main outcome(s) and measure(s) Study endpoints included discharge neurologic examination, post-procedural infarct burden, 3-month functional outcomes, and treatment durability.Results A total of 107 patients with symptomatic angiographically-confirmed cervical ICAO without tandem LVO were identified. Median admission NIH Stroke Scale (NIHSS) score was 8 (IQR 11). Baseline radiographic stroke severity was assessed by ASPECT score (median 9; IQR 2), perfusion mismatch (present in 93%), and clinical imaging mismatch (42%). Median time from symptom onset to treatment was 25 hours (IQR 61). Successful revascularization was achieved in 92% of patients. At discharge, 83% had stable/improved NIHSS score, while at 3 months 65% achieved independence (modified Rankin Scale score ≤2). The most common complication was distal embolization (22%) of which 16% required intra-arterial treatment. Rate of significant restenosis (≥70%) was 15% at 1 year.Conclusions Stenting in selected patients at risk of neurologic deterioration due to symptomatic ICAO can be performed with high rates of technical success and good clinical outcomes. Because of significant peri-procedural risks and high rates of restenosis, randomized studies are necessary to understand the benefit of this approach.