American Journal of Neuroradiology 26:2591-2594, November-December 2005
© 2005 American Society of Neuroradiology
INTERVENTIONAL
Endovascular Recanalization of Internal Carotid Artery Occlusion in Acute Ischemic Stroke
a Department of Neurology, University of Texas–Houston Medical School, Houston, TX
b Department of Radiology, University of Texas–Houston Medical School, Houston, TX
Address correspondence to James C. Grotta, MD, Department of Neurology, University of Houston–Texas, 6431 Fannin–MSB 7.128, Houston, TX 77030
BACKGROUND: Endovascular therapy (ET) of internal carotid artery (ICA) stenosis is equivalent to carotid endarterectomy for stroke prevention; however, patients with ICA occlusion and acute symptoms are traditionally not candidates for ET. We report our experience in endovascular recanalization of acute stroke patients with ICA occlusion.
PATIENTS AND TECHNIQUES: We reviewed our registry for acute stroke patients treated with ET who had (1) ICA occlusion by digital subtraction angiography (thrombolysis in myocardial ischemia=0) with location of type II (above ophthalmic artery involving M1 or A1 but not both) or type III (proximal to the ophthalmic artery but distal to the bifurcation); (2) acute stroke symptoms from the index lesion presenting 3 hours after onset of symptoms; (3) minimal ischemic changes on brain CT scan (less than one third of the MCA territory); (4) attempted ET. Neuroradiologists reviewed angiograms for thrombolysis in cerebral infarction. A blinded vascular neurologist reviewed postprocedural brain imaging for Alberta Stroke Program Early CT (ASPECT) scoring. Outcome scales were assessed.
RESULTS: We identified 14 patients, 10 of whom were men (mean age, 58 ± 14 years; median age, 54 years; age range, 40–74 years). There were 8 left ICA occlusions, 3 type II; and 6 right ICA occlusions, one type II. Median baseline National Institutes of Health Stroke Scale score was 17 (range, 11–25; mean, 18 ± 4.9). Mean time to ET was 389 ± 103 minutes (median, 306 minutes; range, 197–1290 minutes). Immediate recanalization occurred in 64%. Decrease in expected stroke volume by brain imaging occurred in 50% with mean ASPECT score of 4 ± 2.9 (median, 3; range, 0–8; 21% 
8). Two hemorrhages occurred, one symptomatic; 3 patients died. Good outcome was achieved in 64% of cases.
CONCLUSION: Endovascular therapy of carotid occlusion in hyperacute stroke patients is feasible and may help to reduce stroke volume and increase good outcome in some patients.
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