Emergent cervical surgical embolectomy for extracranial internal carotid artery occlusion

Kiyofuji, Satoshi; Inoue, Tomohiro; Tamura, Akira; Saito, Isamu

doi:10.1007/s00701-015-2478-5

Cited by 7 publications

(17 citation statements)

References 20 publications

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“…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).…”

Section: Discussionmentioning

confidence: 48%

“…However, endovascular treatment allows for the treatment of intracranial vessel occlusions. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The current results are real-life data and should only be interpreted together with other available retrospective studies. 5,12,[30][31][32][33][34]…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

See 3 more Smart Citations

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

Schubert

Witte

Settmacher

et al. 2018

Vasc Endovascular Surg

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Ischemic stroke due to an acute occlusion of the extracranial internal carotid artery (eICA) is associated with high morbidity and mortality. The best treatment option remains unclear. This study aims to increase the available therapeutic experience documented for surgical recanalization of acute eICA occlusions. We retrospectively reviewed all hospital records of the University Hospital Jena between 2006 and 2018 to identified patients with acute ischemic stroke due to an occlusion of the eICA who underwent emergent surgical recanalization. We analyzed clinical data, surgical reports, imaging data, and outpatient records. The primary outcome parameter was the modified Rankin Scale (mRS) at 3 months. During the survey, 12 patients (mean age: 62.3 ± 10.8 years; range: 35-87) underwent emergent surgical recanalization for an acutely symptomatic eICA occlusion. All patients presented with neurological deficits with a mean National Institutes of Health Stroke Scale score at admission of 15.0 ± 5.1 (range 2-23). Patients were selected for surgery mainly due to the extent of the perfusion mismatch, while stroke severity and age were also considered. The median time from symptom onset to surgery was 309 ± 122 minutes (range 112-650 minutes). Complete recanalization was obtained in all 12 patients. No patient deteriorated postoperatively, no intracranial hemorrhage was observed, and no patient died in the following 3 months. Favorable outcomes (mRS: 0-2) after 3 months were achieved in 7 of 12 patients. The current study adds support to previous findings that the surgical recanalization of acute eICA occlusions is a possible and safe treatment option. However, a critical patient selection based on mismatch size in perfusion imaging is crucially important for successful treatment.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The current results are real-life data and should only be interpreted together with other available retrospective studies. 5,12,[30][31][32][33][34]…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

See 2 more Smart Citations

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

Schubert

Witte

Settmacher

et al. 2018

Vasc Endovascular Surg

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show abstract

“…Prior studies have shown that up to 8% of AIS may be due to ICA stenosis, 7 whereas acute cardiogenic emboli resulting in extracranial ICA occlusions account for only 0.3% of strokes. 16 Likewise, we were not able to determine the timing of angioplasty or stenting required to traverse the ICA and gain intracranial access given the retrospective nature of the study. Finally, it is difficult to discern any potential effect that ACA infarctions may have had on this small study population.…”

Section: Limitationsmentioning

confidence: 99%

Severe carotid stenosis and delay of reperfusion in endovascular stroke treatment: an Interventional Management of Stroke-III study

Gogela¹,

Gozal²,

Zhang

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The impact of extracranial carotid stenosis on interventional revascularization of acute anterior circulation stroke is unknown. The authors examined the effects of high-grade carotid stenosis on the results of endovascular treatment of patients in the Interventional Management of Stroke (IMS)-III trial. METHODS The 278 patients in the endovascular arm of the IMS-III trial were categorized according to the degree of carotid stenosis as determined by angiography. In comparing patients with severe stenosis or occlusion (≥ 70%) to those without severe stenosis (< 70%), the authors evaluated the time to endovascular reperfusion, modified Thrombolysis in Cerebrovascular Infarction (mTICI) scores, 24-hour mean infarct volumes, symptomatic intracerebral hemorrhage rates, and modified Rankin Scale (mRS) scores at 90 days. RESULTS Compared with the 249 patients with less than 70% stenosis, patients with severe stenosis (n = 29) were found to have a significantly longer mean time to reperfusion (105.7 vs 77.7 minutes, p = 0.004); differences in mTICI scores, infarct volumes, hemorrhage rates, and mRS scores at 90 days did not reach statistical significance. Multiple regression analysis revealed that severe carotid stenosis (p < 0.0001) and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.004) were associated with an increase in time to reperfusion. Older age (p < 0.0001), higher NIHSS score (p < 0.0001), and the absence of reperfusion (p = 0.001) were associated with worse clinical outcomes. CONCLUSIONS Severe ipsilateral ICA stenosis was associated with a significantly longer time to reperfusion in the IMS-III trial. Although these findings may not translate directly to modern devices, this 28-minute delay in reperfusion has significant implications, raising concern over the treatment of tandem ICA stenosis and downstream large-vessel occlusion.

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Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

Malhotra

Goyal

Tsivgoulis

2017

Curr Atheroscler Rep

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Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO. Recent success of endovascular therapy for vessel occlusion in anterior circulation has expanded the horizons; however, few patients with cervical dissections and ICAO were included in these landmark trials. Acute ICAO responds poorly to intravenous thrombolysis and portends worse clinical outcomes. Extracranial and intracranial ICAOs have varied clinical course and imaging patterns, with discrete cervical ICAO usually associated with better clinical outcomes while tandem occlusions predispose poor outcomes. Diagnostic catheter-based angiogram is often required since appearances of ICAO using non-invasive neuroimaging modalities are often deceiving. Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.

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Emergent cervical surgical embolectomy for extracranial internal carotid artery occlusion

Abstract: Cervical surgical embolectomy for acute extracranial ICA occlusion resulted in a high complete recanalization rate with an acceptable safety profile. A possible association between severe cardiac illness and huge embolus occluding proximal large artery was suggested.

Cited by 7 publications

References 20 publications

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

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

Severe carotid stenosis and delay of reperfusion in endovascular stroke treatment: an Interventional Management of Stroke-III study

Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

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