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Updated: Jul 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical Thrombectomy for Acute Cardiogenic Internal Carotid Artery Occlusion with Cross-Flow through the
Seigo Kimura1, Ryokichi Yagi, Fumihisa Kishi
1Kouzenkai Yagi Neurosurgical Hospital, Osaka, Japan.
Insights
Mechanical thrombectomy for internal carotid artery occlusion with cross-flow shows longer treatment times and poorer outcomes. Despite smaller low-perfusion regions, intervention is crucial for these high-risk stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Internal carotid artery (ICA) occlusion poses a significant stroke risk.
- Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke.
- Understanding the impact of collateral flow on MT outcomes is critical.
Purpose of the Study:
- To evaluate mechanical thrombectomy (MT) outcomes in patients with internal carotid artery (ICA) occlusion and cross-flow via communicating arteries.
- To compare these outcomes with cases of ICA or middle cerebral artery occlusion lacking cross-flow.
Main Methods:
- Retrospective analysis of 10 cases with cross-flow ('with' group) and 57 cases without cross-flow ('without' group).
- Utilized Rapid Processing of Perfusion and Diffusion (RAPID) software for analysis since October 2020.
Main Results:
- The 'with' group experienced significantly longer puncture-to-reperfusion times (78.5 vs. 39 min) and higher discharge NIH Stroke Scale scores (10.5 vs. 4).
- Patients with cross-flow had worse functional outcomes at 90 days (mRS 4 vs. 2) and greater diffusion-weighted imaging score decline (0.5 vs. 0).
- The 'with' group showed smaller Tmax > 6s volumes (50 cc vs. 164 cc), indicating a potentially smaller ischemic core but still a significant low-perfusion state.
Conclusions:
- Internal carotid artery occlusion with cross-flow presents challenges, including longer treatment times and potential for distal thrombus migration.
- Despite smaller identified hypoperfused volumes, the presence of a Tmax > 6s region necessitates mechanical thrombectomy due to the risk of cerebral infarction.
- MT should be considered even in the 'with' group, acknowledging the higher risk profile and potential for poorer prognosis.
Aim:
To report mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with cross-flow through the communicating artery ("with" group), and to compare it with ICA or middle cerebral artery occlusion without cross-flow ("without" group).
Material And Methods:
This study included 10 and 57 cases of the "with" and "without" groups, respectively. Cases analyzed by rapid processing of perfusion and diffusion (RAPID) since October 2020 were included.
Results:
Puncture-to-reperfusion time was 78.5 and 39 min (p=0.0155), the National Institutes of Health Stroke Scale score at discharge was 10.5 and 4 (p=0.0166), decline from pre to post Diffusion-Weighted Image-Alberta Stroke Program Early computed tomography (CT) Score was 0.5 and 0 (p=0.0495), and the modified Rankin Scale score at 90 days was 4 and 2 (p=0.0195) in the "with" and "without" groups, respectively. Furthermore, Tmax values of > 6 s (50 cc vs. 164 cc; p=0.0277) and Tmax > 4 s/Tmax > 6 s ratio (3.23 vs. 1.55) (p=0.0074) were significantly different between the "with" and "without" groups.
Conclusion:
The "with" group may have been affected by the longer treatment time and being at high risk of distal migration of thrombus due to poor prognosis. Although the region with a Tmax of > 6 s tends to be small in patients of the "with" group, it indicates a low-perfusion state that can lead to cerebral infarction, and MT should be performed.
