Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery

Abstract

Early identification by duplex imaging of an occlusion or severe stenosis of the ICA ipsilateral to a hemispheric ischemic stroke might improve selection of patients who could be treated with emergent anticoagulation. Further testing of this approach is needed.

Emergent Stenting of Extracranial Internal Carotid Artery Occlusion in Acute Stroke Has a High Revascularization Rate

“…1 Carotid occlusion with hemodynamic impairment portends a particularly worse prognosis being associated with early clinical deterioration and late stroke recurrence risk. 2,3 In this group of patients, early restoration of flow in the occluded ICA may improve the symptoms of acute stroke, prevent worsening, and reduce long-term stroke recurrence risk.…”

Prognostic Factors for Neurologic Outcome after Endovascular Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery

“…Optimal management of an ICA occlusion with a concomitant MCA occlusion has not been clearly established, though MCA occlusion can only be a target of revascularization. [12][13][14][15] The prognosis for patients with acute progressive stroke caused by carotid occlusion is known to be poor, with only 2%-12% good recovery. 16 In addition, the management of patients with acute symptomatic carotid artery occlusion remains controversial, though the angiographic finding of ICA occlusion reveals a spectrum of ICA occlusions, as well as a tandem lesion in the intracranial artery in addition to the level (below or above the ophthalmic artery) and type (atherosclerotic or embolic) of lesion.…”

Intra-Arterial Thrombolysis of Occluded Middle Cerebral Artery by Use of Collateral Pathways in Patients with Tandem Cervical Carotid Artery/Middle Cerebral Artery Occlusion

“…16 Furthermore, the presence of tandem cervical ICA and proximal MCA occlusion independently predicted poor recanalization and outcome. 17 Tandem cervical ICA and proximal MCA occlusion can cause a decrease in regional cerebral perfusion pressure, which may hamper dissolution of an MCA clot after intravenous thrombolysis.…”

“…16 The lenticulostriate arteries (LSAs) are functional end-arteries without collateral. Thrombus in the proximal segment of the MCA may lead to occlusion of the orifices of these arteries and cause cerebral infarction.…”