Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Acute internal carotid artery occlusion (ICAO) leads to significant morbidity and mortality worldwide.
• ICAO is associated with large infarcts and poor clinical outcomes.

Purpose of the Study:

• To review the etiologies, pathophysiology, clinical presentations, radiographic patterns, and management of acute ICAO.
• To explore current and emerging treatment strategies for ICAO.

Main Methods:

• Literature review of studies on acute internal carotid artery occlusion.
• Analysis of clinical presentations, imaging findings, and treatment outcomes.

Main Results:

• Systemic thrombolysis shows suboptimal recanalization rates for acute ICAO.
• Endovascular therapy offers expanded treatment options, though its role in specific ICAO subtypes like cervical dissections requires further investigation.
• Extracranial and intracranial ICAOs exhibit varied clinical courses and imaging patterns; tandem occlusions are linked to poorer outcomes compared to discrete cervical ICAO.
• Diagnostic catheter-based angiography is often necessary due to limitations of non-invasive imaging.
• Repeated vascular imaging is crucial for monitoring recanalization and guiding secondary prevention strategies.

Conclusions:

• Acute ICAO often responds poorly to intravenous thrombolysis, necessitating advanced treatment approaches.
• Endovascular procedures represent a growing frontier in improving ICAO management.
• Personalized management strategies based on occlusion location and imaging patterns are essential for optimizing patient outcomes.