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Updated: Jun 2, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Emergent endovascular recanalization for cervical internal carotid artery occlusion in patients presenting with acute
Erik F Hauck1, Sabareesh K Natarajan, Hajime Ohta
1Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA.
Insights
Emergent endovascular recanalization for acute internal carotid artery (ICA) occlusion shows promise, especially in younger patients. Successful treatment led to good outcomes in 50% of patients, with younger age and recanalization being key predictors.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Acute proximal internal carotid artery (ICA) occlusion presents a risk of hemispheric ischemia, influenced by collateral circulation.
- The study addresses the variable outcomes associated with cervical ICA occlusion.
Purpose of the Study:
- To evaluate clinical outcomes of emergent endovascular carotid recanalization for acute cervical ICA occlusion.
- To identify predictors of successful recanalization and favorable clinical, neurological, and functional outcomes.
Main Methods:
- Retrospective analysis of 22 patients undergoing emergent endovascular revascularization for acute cervical ICA occlusion.
- Exclusion of patients with pseudo-occlusion.
- Assessment of recanalization using the Thrombolysis in Myocardial Ischemia (TIMI) scale (grades 0-3).
Main Results:
- Recanalization (TIMI grade 2/3) was achieved in 77.3% of patients.
- 45.5% experienced significant clinical improvement (NIHSS score improved ≥4 points).
- Good outcomes (modified Rankin Scale ≤2) were observed in 50% at 3-month follow-up. Younger age (<70 years) and successful recanalization predicted good outcomes. Poor outcomes were associated with atrial fibrillation, high NIHSS scores (≥20), and complete occlusion at all levels. Patients with distal vessel preservation showed the best results (88.2% recanalization, 64.7% good outcome).
Conclusions:
- Emergent endovascular carotid recanalization is a viable option for acute stroke secondary to cervical ICA occlusion.
- The procedure is particularly encouraged for younger patients and those with partial distal ICA preservation, offering a higher likelihood of successful recanalization and good functional outcomes.
Background:
Acute proximal (cervical) internal carotid artery (ICA) occlusion may cause ischemia of an entire hemisphere or no ischemia at all, depending on the presence of intracranial collaterals.
Objective:
To retrospectively analyze the clinical results for emergent endovascular carotid recanalization in patients with acute proximal (cervical) ICA occlusion and to assess predictors of recanalization and clinical, neurological, and functional outcome.
Methods:
Emergent endovascular revascularization was attempted in 22 patients presenting with acute stroke secondary to complete cervical ICA occlusion. Patients with pseudo-occlusion were excluded. Recanalization was assessed with the Thrombolysis in Myocardial Ischemia (TIMI) system: grade 0 (no flow) to grade 3 (normal flow).
Results:
The median age of the patients was 65 years; mean admission National Institutes of Health Stroke Scale (NIHSS) score was 14. Recanalization (TIMI grade 2/3) occurred in 17 patients (77.3%). Ten patients (45.5%) demonstrated significant clinical improvement during hospitalization (NIHSS improved ≥4 points). Fifty percent of patients had good outcomes (modified Rankin Scale ≤2) after a median follow-up of 3 months. Patient age <70 years and successful recanalization (TIMI grade 2/3) predicted a good outcome (P ≤ .01). Presence of atrial fibrillation, admission NIHSS score ≥20, and complete ICA occlusion at all levels (cervical, petrocavernous, and intracranial) were associated with poor outcomes (P ≤ .05). Patients with complete cervical ICA occlusion but partial distal preservation of the vessel were most likely to benefit from the intervention (recanalization in 88.2%; good outcome in 64.7%).
Conclusion:
Attempts at emergent endovascular carotid recanalization for acute stroke are encouraged, particularly in younger patients with partial distal preservation of the ICA.