Article Text
Abstract
Introduction Acute occlusion of internal carotid artery (ICA) is the underlying etiology in up to 15% of all ischemic strokes and is often associated with greater severity, functional disability, and mortality. There are no clear guidelines on the acute management of isolated extracranial ICA occlusion without intracranial occlusion. There is limited data on endovascular intervention versus medical management benefit.
Methods We conducted a retrospective chart review at our comprehensive stroke center, including subjects ≥18 from 2021–2023 who presented with isolated acute extracranial ICA occlusion with patent intracranial flow. We included patients who had emergent or delayed endovascular therapy (EVT) and compared to those who had only medical management. Data collected included age, gender, preadmission mRS, admission NIHSS, administration of intravenous thrombolysis (IVT), symptomatic intracerebral hemorrhage (sICH), discharge NIHSS, discharge and 90 day mRS, and mortality. Univariate analysis was completed.
Results 35 patients were included with mean age 62.1 (37% female). 45.7% underwent EVT with angioplasty, 20% also receiving IVT. The majority of patients who underwent EVT received it promptly upon arrival, whereas 18.8% received it after a delay. The discharge mRS of patients who received EVT promptly upon arrival was significantly worse versus those who received after a delay (5 vs. 2.3; p=0.042). Also, in those who received EVT compared to medical management, there was a nonsignificant trend towards higher admission NIHSS (16.5 vs 12.7), higher sICH (25% vs 5.3%), and higher mortality (37.5% vs 15.8%). Please refer to table 1 for further details.
Conclusion In this retrospective review with limited numbers, there was a suggestion of an improved discharge outcome in those who received EVT after a delay than those who immediately had EVT. Future research is needed to identify clinical criteria in those with isolated extracranial ICA occlusions who may benefit from EVT.
Disclosures S. Lingam: None. W. Liu: None. V. Galate: None. A. Brake: None. S. Slavin: None.