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Recanalization Rate and Clinical Outcome in Acute Carotid-T Occlusion
Young Noh1, Cheol Kyu Jung, Jeong-Ho Hong
1Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea.
Insights
Complete recanalization for acute carotid-T occlusion improves patient outcomes. Bridging intravenous/intra-arterial thrombolysis may offer better results than intra-arterial alone for stroke treatment.
Area of Science:
- Neurology
- Vascular Medicine
- Interventional Neuroradiology
Background:
- Acute carotid-T occlusion presents significant challenges with low recanalization rates and poor patient outcomes.
- Thrombolytic therapy is a critical intervention for acute ischemic stroke.
- Investigating rare cases of carotid-T occlusion provides valuable insights into treatment efficacy.
Purpose of the Study:
- To evaluate clinical outcomes and recanalization rates in patients with acute carotid-T occlusion treated with thrombolysis.
- To compare the effectiveness of bridging intravenous (IV) plus intra-arterial (IA) thrombolysis versus IA alone.
- To identify factors associated with favorable outcomes in this patient population.
Main Methods:
- Analysis of a consecutive series of 40 patients with acute carotid-T occlusion.
- Treatment modalities included bridging IV/IA thrombolysis or IA thrombolysis alone.
- Complete recanalization defined as TICI grade 3; favorable outcome defined as mRS score ≤2.
Main Results:
- 15% of patients (6/40) achieved favorable outcomes, while 85% (34/40) had poor outcomes.
- Favorable outcomes were significantly linked to lower NIHSS scores post-revascularization and higher complete recanalization rates (p < 0.01, p < 0.024).
- Complete recanalization occurred in all patients with favorable outcomes; 83% of these received combined IV/IA thrombolysis.
Conclusions:
- Complete recanalization is crucial for improving clinical outcomes in acute carotid-T occlusion.
- Bridging IV/IA thrombolysis appears more effective than IA alone for achieving favorable outcomes.
- Further research into optimizing thrombolytic strategies for carotid-T occlusion is warranted.
Background:
Acute carotid-T occlusion results in both low recanalization rates and poor outcomes. We investigated clinical outcomes and recanalization in a rare case of thrombolytic therapy.
Methods:
A consecutive series of patients with acute carotid-T occlusion who were treated with either bridging intravenous (IV) plus intra-arterial (IA) thrombolysis or IA alone were analyzed. Complete recanalization was defined as a thrombolysis in cerebral infarction (TICI) grade of 3. A favorable outcome was defined as a modified Rankin Scale (mRS) score of ≤2.
Results:
Of the 40 patients, 6 (15%) had favorable outcomes, and 34 (85%) had poor outcomes. Favorable outcomes were significantly associated with a lower National Institutes of Health Stroke Scale (NIHSS) score after revascularization treatment and higher rates of complete recanalization (p < 0.01, p < 0.024, respectively). Complete recanalization was achieved in all patients with favorable clinical outcomes and 5 (83%) patients had received combined IV/IA thrombolysis (p = 0.381).
Conclusions:
The results suggest that complete recanalization for acute carotid-T occlusion improves clinical outcomes. In that regard, bridging IV/IA thrombolysis may be more efficacious than IA alone.
