Mechanical Thrombectomy for Acute Intracranial Internal Carotid Artery Occlusion Compared with Middle Cerebral Artery Occlusion

Abstract

Objective: We evaluated outcomes after mechanical thrombectomy for intracranial internal carotid artery occlusion (ICO) in comparison with middle cerebral artery occlusion (MCO), and evaluated its pathophysiology and future problems. Methods:A retrospective study was performed in 28 patients (14 patients with intracranial ICO and 14 with MCO) who underwent mechanical thrombectomy using the Penumbra System, TrevoProvue, or Solitaire FR in 2014 and 2015. Assessment was performed mainly using the modified Rankin scale after 30 days and at the time of discharge. Results:The interval from onset to arrival at the hospital (onset to door) and the findings of imaging techniques did not differ between the groups with intracranial ICO or MCO, but the National Institutes of Health Stroke Scale (NIHSS) score on hospital arrival was higher in the former group (21 vs 16, p = 0.028). The favorable recanalization rate was 78% in each group. However, the rates of favorable outcomes were 14.3% and 42.9%, and the mortality rates were 29% and 7.1% in the group with internal carotid artery cerebral artery occlusion and that with MCO, respectively, showing poor outcomes in the former (p = 0.04). Conclusion:In the patients with intracranial ICO, although favorable recanalization was achieved by mechanical thrombectomy, the functional outcome was poor. These results suggest more rapid progression of neurological deficits in the patients with intracranial ICO than those with MCO and the need for even earlier favorable recanalization in the former.