Open AccessEndovascular Reperfusion for Acute Isolated Cervical Carotid Occlusions: The Concept of “Hemodynamic Thrombectomy”
Author(s) -
Luís Henrique de Castro-Afonso,
Guilherme Seizem Nakiri,
Lucas Moretti Monsignore,
Francisco Antunes Dias,
Frederico Fernandes Aléssio-Alves,
Marco Túlio Salles Rezende,
Felipe Padovani Trivelato,
Octávio Marques Pontes-Neto,
Daniel Giansante Abud
Publication year - 2018
Publication title -
interventional neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.07
H-Index - 5
eISSN - 1664-9737
pISSN - 1664-5545
DOI - 10.1159/000493021
Subject(s) - medicine , thrombolysis , modified rankin scale , stroke (engine) , internal carotid artery , occlusion , endovascular treatment , collateral circulation , cardiology , hemodynamics , surgery , myocardial infarction , ischemia , ischemic stroke , aneurysm , mechanical engineering , engineering
Background/Aims: Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods: Of a consecutive series of 223 patients who were admitted with acute ischemic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results: The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions: The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries’ stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions.