Related Experiment Video
Updated: Jul 18, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Percutaneous recanalization of acute internal carotid artery occlusions in patients with severe stroke
Rainer Dabitz1, Stefan Triebe, Ullrich Leppmeier
1Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany.
Insights
Mechanical recanalization of carotid artery occlusions offers a promising rescue therapy for severe stroke. This interventional procedure significantly improved patient outcomes, even in critical cases.
Area of Science:
- Interventional Neurology
- Vascular Neurology
- Neurocritical Care
Background:
- Sudden symptomatic occlusions of the proximal internal carotid artery (ICA) often lead to severe middle cerebral artery (MCA) ischemia and stroke.
- These cases are frequently inaccessible to standard thrombolysis (rt-PA), carrying a poor prognosis.
- Mechanical recanalization emerged as a critical rescue strategy.
Purpose of the Study:
- To evaluate the efficacy of mechanical recanalization of proximal ICA occlusions as a rescue procedure.
- To assess the impact of this intervention on patient outcomes in severe stroke cases.
- To determine the feasibility of combining mechanical recanalization with fibrinolysis.
Main Methods:
- Ten patients with proximal ICA occlusions underwent emergency mechanical recanalization using stents and/or balloon angioplasty.
- Procedures included percutaneous transluminal angioplasty (PTA) or primary stenting.
- Patients received bridging therapy with rt-PA (without abciximab).
Main Results:
- Successful recanalization of the proximal ICA was achieved in all patients.
- Intracerebral arteries showed at least partial recanalization in all, with complete recanalization in 5 patients.
- Marked improvement was observed at discharge (9/10 patients), with 7/8 patients achieving a modified Rankin Scale (mRS) score of ≤2 at follow-up.
Conclusions:
- Primary mechanical recanalization of ICA occlusions, combined with fibrinolysis, is a feasible and effective rescue therapy.
- This approach significantly improves patient outcomes in severe ischemic stroke.
- The technique offers a vital option for previously untreatable stroke presentations.
Background:
Sudden symptomatic occlusions of the proximal internal carotid artery (ICA) resulting in severe middle cerebral artery (MCA) ischemia and stroke are usually not accessible by rt-PA thrombolysis and the prognosis is usually very poor. Mechanical recanalization of the proximal ICA combined with intravenous and intra-arterial thrombolysis was therefore used as a rescue procedure.
Methods:
Ten patients (9 men, 1 woman; mean age 56.1 years) were treated with emergency recanalization of the proximal carotid artery by using stents and/or balloon angioplasty as a rescue procedure. Three patients showed dissection, and 7 had atherothrombotic occlusions. Nine of 10 presented with an initial modified Rankin Scale (mRS) of 5, the remaining patient with mRS 4 (average NIHSS 21.4). After sonographic confirmation of ICA with associated MCA/distal ICA occlusion and bridging with rt-PA (without abciximab) an emergency angiography was performed with subsequent mechanical recanalization by percutaneous transluminal angioplasty (PTA) (n = 1) or primary stenting (n = 9) using self-expanding stents. Distal protection was used in 1 of 10 patients.
Results:
Recanalization of the proximal ICA was achieved in all. At least partial recanalization of the intracerebral arteries was achieved in all, and complete recanalization in 5. In 4 of 10 patients limited hemorrhage was detected during CT controls. Major complications included 2 patients who had to undergo hemicraniectomy. One patient died from malignant infarction. At the time of discharge from the stroke unit 9 of 10 patients had improved markedly, 5 patients having an mRS of < or =2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS < or =2, and 1 a mRS of 3.
Conclusions:
Primary mechanical recanalization of ICA occlusions by stent and PTA combined with fibrinolysis and/or GPIIb/IIIa-receptor antagonists seems to be feasible to improve patient outcome significantly.
