Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery

Abstract

Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

Acute Stroke Treatment by Surgical Recanalization of Extracranial Internal Carotid Artery Occlusion: A Single Center Experience

“…Following surgery, reports of good clinical outcomes varied considerably, with rates of 23%, 36 38%, 12 63.6%, 30 71.4%, 31 75%, 5 and up to 83.3%. 34 Our data, with a 58% favorable outcome, are in the middle of the reported results. Mortality rates showed also a considerable variability between studies [6%, 36 21%, 12 9%, 30 0% 5,31,34 ] and 0% in the current study.…”

“…34 Our data, with a 58% favorable outcome, are in the middle of the reported results. Mortality rates showed also a considerable variability between studies [6%, 36 21%, 12 9%, 30 0% 5,31,34 ] and 0% in the current study. Mortality, in particular, seems low when compared to the general use of t-PA (∼15%-25% mortality).…”

“…However, other studies have also reported favorable outcomes in patients with NIHSS scores at admission of >20. 30,34 In the current study, there were 2 patients with an initial NIHSS score of >20 (23 and 21) and a favorable outcome. The importance of the admission NIHSS score seems to also be reasonable from a theoretical perspective, as it expresses the mismatch between perfusion restriction and clinical symptoms.…”

“…Previous studies have suggested that the existence of functional collaterals and the resulting amount of salvageable brain tissue is the most important factor for patient selection. 34,38 In the current study, the admission NIHSS score also seems to be important, because all patients with an admission NIHSS 13 had a favorable outcome. However, other studies have also reported favorable outcomes in patients with NIHSS scores at admission of >20.…”

“…Although there are no randomized trials and comparisons between endovascular and surgical treatments are difficult to make, the available studies investigating surgical thrombectomy tend to report better recanalization rates (95% to 100%) and better outcomes (mRS < 2 in 40% to 80%). 5,12,[30][31][32][33][34][35] Also, the mortality of patients after endovascular treatment of eICA occlusions is comparable high with *18%. 29 One possible reason for the differences between these methods is the risks of fragmentation of a large occlusive thrombus during endovascular treatment and the subsequent embolization of intracranial vessels.…”