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Outcome and Treatment Effects in Stroke Associated with Acute Cervical ICA Occlusion

Michael Gliem1, John-Ih Lee1, Aurica Barckhan1

  • 1Department of Neurology, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany.

Plos One
|January 13, 2017
PubMed

Insights

Endovascular therapy improved outcomes for tandem occlusions but not isolated cervical internal carotid artery (ICA) occlusions. Intracranial vessel patency is key for treatment decisions in acute cervical ICA stroke.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Neuroradiology

Background:

  • Endovascular therapy (EVT) with stent retrievers plus i.v. thrombolysis (IVT) is effective for middle cerebral artery (MCA) and distal internal carotid artery (ICA) occlusions.
  • Limited data exist on acute cervical ICA occlusion, especially tandem occlusions (cervical + intracranial).
  • This study analyzes outcomes in cervical ICA occlusion, focusing on the impact of intracranial patency.

Purpose of the Study:

  • To evaluate outcomes and treatment effects in acute stroke patients with cervical ICA occlusion.
  • To specifically assess the impact of intracranial ICA or M1 segment patency on treatment decisions.
  • To compare outcomes between isolated cervical ICA occlusion and tandem occlusions.

Main Methods:

  • Retrospective analysis of 78 patients with cervical ICA occlusion.
  • Outcome parameters included Thrombolysis in Cerebral Infarction (TICI) classification, infarct size, modified Rankin scale (mRS), symptomatic intracerebral hemorrhage (ICH), and death.
  • Patients were categorized by occlusion type (isolated cervical vs. tandem) and treatment (IVT alone, IVT/EVT, or no treatment).

Main Results:

  • 35 patients had tandem occlusions, 43 had isolated cervical ICA occlusions.
  • Tandem occlusion patients had worse outcomes than isolated cervical ICA occlusion patients, regardless of treatment.
  • EVT improved outcomes in tandem occlusions (OR 15.43) but not in isolated cervical ICA occlusions (OR 1.33).

Conclusions:

  • Stroke outcome in isolated cervical ICA occlusion is generally favorable and not improved by adding EVT to IVT.
  • EVT significantly improves outcomes in tandem occlusions (cervical + intracranial ICA).
  • Intracranial vessel patency is a critical factor in guiding treatment decisions for acute cervical ICA occlusion.
Abstract

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