Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Emergent Recanalization with Stenting for Acute Stroke due to Athero-Thrombotic Occlusion of the Cervical Internal Carotid Artery : A Single Center Experience

  • Choi, Jae Young (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Jae Il (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital) ;
  • Lee, Tae Hong (Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital) ;
  • Sung, Sang Min (Department of Neurology, Medical Research Institute, Pusan National University Hospital) ;
  • Cho, Han Jin (Department of Neurology, Medical Research Institute, Pusan National University Hospital) ;
  • Ko, Jun Kyeung (Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital)
  • Received : 2014.01.27
  • Accepted : 2014.06.11
  • Published : 2014.06.28
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Abstract

Objective : The purpose of this study is to demonstrate the technical feasibility and clinical efficacy of emergent carotid angioplasty and stenting (CAS) for acute stroke due to athero-thrombotic occlusion of the cervical internal carotid artery (ICA). Methods : Review of medical records identified 17 patients who underwent emergent CAS for treatment of athero-thrombotic occlusion of the cervical ICA with acute stroke between 2009 and 2013. Eleven patients (64.7%) presented with concomitant intracranial artery occlusion, which was treated primarily by mechanical thrombectomy after CAS. Results : Successful revascularization of the cervical ICA with emergent CAS was achieved in all patients. After CAS, intracranial recanalization with Thrombolysis in Cerebral Infarction ${\geq}2b$ flow was achieved in four of the 11 patients (36.4%). The overall recanalization rate (cervical ICA and intracranial artery) was 10 of 17 patients (58.8%). Symptomatic intracranial hemorrhage occurred in two patients (11.8%), resulting in death. Ten patients (58.8%) showed improvement (decrease in NIHSS score of ${\geq}4$ points) at seven days after recanalization. Nine patients (52.9%) showed a favorable outcome ($mRS{\leq}2$) at the last follow-up. A favorable outcome ($mRS{\leq}2$) was obtained in four of the six patients with isolated cervical ICA occlusion (4/6, 66.7%) and five of 11 patients with intracranial tandem occlusion (5/11, 45.5%). Conclusion : Emergent CAS for acute stroke due to athero-thrombotic occusion of the cervical ICA showed a good technical feasibility and favorable clinical outcome.

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References

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