Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery
Language English Country United States Media print-electronic
Document type Journal Article
- Keywords
- acute ischemic stroke, carotid artery occlusion, carotid endarterectomy, internal carotid artery, outcome, penumbra,
- MeSH
- Acute Disease MeSH
- Carotid Artery, Internal diagnostic imaging physiopathology surgery MeSH
- Time-to-Treatment MeSH
- Time Factors MeSH
- Stroke diagnosis etiology mortality physiopathology MeSH
- Computed Tomography Angiography MeSH
- Angiography, Digital Subtraction MeSH
- Brain Ischemia diagnosis etiology mortality physiopathology MeSH
- Endarterectomy, Carotid * adverse effects mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- Cerebral Angiography methods MeSH
- Cerebrovascular Circulation MeSH
- Emergencies MeSH
- Perfusion Imaging methods MeSH
- Disability Evaluation MeSH
- Vascular Patency MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Carotid Stenosis complications diagnostic imaging mortality surgery MeSH
- Severity of Illness Index MeSH
- Thrombolytic Therapy MeSH
- Patient Selection MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. RESULTS: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). CONCLUSION: 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.
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