Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries

Abstract

Purpose Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3-month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3-month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome. Keywords Circle of Willis • Large vessel occlusion • Stroke severity • Endovascular treatment • OutcomeAvailability of data and material Data supporting the findings of this study are available upon reasonable request

Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

“…Furthermore, this factor affects the mortality rate, which was 2% in the rst group and 33% in the second group (p = 0.015). This data is in accordance with a previous study which found a correlation between recanalization and outcome in acute ischemic stroke: recanalization is strongly associated with improved functional outcome and reduced mortality [19,33].…”

Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion

“…Accounting for 4% of anterior large vessel occlusions, the rate of patients with isolated ICA occlusion treated in our centers was consistent with the MERCI and Multi-MERCI analyses but lower than the rate (7.8%) reported by the Italian Registry of Endovascular Treatment in Stroke [ 6 , 13 ]. Compared with the MR CLEAN and REVASCAT trials [ 4 , 5 ], these rates indicate the higher likelihood of facing a patient with AIS due to isolated ICA occlusion in a real-world setting.…”

“…Recently, one study investigated the benefit of initial BMT in patients with isolated ICA occlusion and reported a favorable outcome in 69% [ 11 ]. This rate is notably higher than that of 2 recent thrombectomy studies, which reported 34% and 26% favorable outcomes, respectively [ 12 , 13 ]; however, this difference in outcomes is likely attributable to variations in the median baseline National Institutes of Health stroke scale (NIHSS) scores.…”

Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms

“…[1][2][3][4][5][6][7][8][9][10] On the other hand, compared with TFA, TRA has been shown to have the following drawbacks: increased radiation exposure due to prolonged operation time; 8 difficulty performing the procedure for anatomic reasons; 4 a lack of TRAspecific devices; and the need for proficiency in the procedure. 2,[11][12][13][14] However, the majority of the literature comparing TRA and TFA is based on reports of diagnostic cerebral angiography, [15][16][17][18][19][20][21] carotid stenting, [22][23][24] vertebral and basilar artery stenting, 25 mechanical thrombectomy, [26][27][28][29] and flow diversion, 30,31 with few studies on intracranial aneurysms.…”