Introduction Carotid artery occlusion in the setting of acute stroke with concurrent intracranial involvement is a serious and deadly combination, and can prove to be a challenging endeavor when encountered. The stroke is usually more severe due to poor collaterals and successful revascularization is difficult to achieve, resulting in a higher morbidity and mortality. We aim to assess the revascularization rates and clinical outcomes in this subset of patients treated with endovascular therapy.

Materials and methods An IRB approved retrospective chart review of cases presenting with acute ischemic stroke with carotid occlusions and concurrent intracranial involvement treated with endovascular therapy over a 4 year period was conducted. Of these reviewed cases, 75 patients had carotid occlusions with intracranial involvement. The carotid T occlusions and critical ICA stenosis with intracranial flow were excluded from the study.

Based on the CT and catheter angiogram findings, the 75 patients fell into two groups:

1. Group A (n=35): Carotid occlusion with underlying atherosclerotic disease/dissection resulting in occlusion and were treated with angioplasty and stenting followed by thrombus retrieval.

2. Group B (n=40): No underlying pathology was found and ICA was occluded due to a large embolus to the ICA with no anterograde flow in the ICA. This group was treated with thrombus retrieval alone.

Results Our data shows that the presence of a stent in the ICA does not adversely affect the intracranial recanalization rate (91.4% TICI ≥2  b). There was also no significant increase in hemorrhage rate with revascularization and antiplatelet therapy (2.9%). This finding was especially significant due to the large amount of wake up strokes in our study that were treated with intervention (17.3%). The successful reperfusion rate (TICI ≥2 b) overall in both groups was 82.7%. In the successfully recanalized group, the mortality was 16 % compared to the mortality in the unsuccessfully recanalized group (69.2% ).

Conclusion Our study results show that it is possible to achieve a high success rate of revascularization and clinical outcomes with an endovascular approach to managing carotid occlusion with intracranial involvement.

Disclosures B. Donegan: None. I. Akhtar: None. C. Boutwell: None. J. Halpin: None. C. Martin: None. W. Holloway: None. N. Akhtar: None.