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Angioplasty of the occluded internal carotid artery
M P Spearman1, C A Jungreis, L R Wechsler
1Department of Radiology, University of Pittsburgh Medical Center, PA 15213-2582, USA.
Insights
Angioplasty successfully recanalized acute atherosclerotic internal carotid artery occlusions in stroke patients. This endovascular approach facilitated intracranial access for thrombolysis with low morbidity.
Area of Science:
- Endovascular neurosurgery
- Cerebrovascular disease management
- Interventional neuroradiology
Background:
- Acute stroke often results from middle cerebral artery (MCA) occlusion.
- Internal carotid artery (ICA) occlusion can coexist with MCA occlusion, complicating stroke treatment.
- Effective recanalization of occluded ICAs is crucial for restoring cerebral blood flow.
Purpose of the Study:
- To review outcomes of angioplasty for acute internal carotid artery occlusions in patients with concurrent MCA occlusion.
- To evaluate the safety and efficacy of recanalizing atherosclerotic ICAs in the setting of acute stroke.
- To assess the utility of successful ICA recanalization for subsequent intracranial interventions.
Main Methods:
- Retrospective review of acute stroke patients treated with intra-arterial urokinase.
- Identification of patients with concomitant MCA and ICA occlusions.
- Angioplasty performed on four atherosclerotic ICA occlusions after successful guidewire traversal.
Main Results:
- All four attempted ICA angioplasties were technically successful, with successful traversal of occlusions.
- No new neurological deficits, vascular injuries, or deaths occurred during the procedures.
- Follow-up at 4-6 months demonstrated sustained patency of the treated ICAs.
Conclusions:
- Angioplasty is a viable and safe option for recanalizing acute atherosclerotic internal carotid artery occlusions in stroke patients.
- Successful ICA recanalization improves endovascular access to the intracranial circulation for thrombolysis.
- This approach offers low morbidity and maintains vessel patency, potentially improving stroke outcomes.
Purpose:
To review patients who have presented with acute strokes from a middle cerebral artery occlusion in whom in addition to the middle cerebral artery thromboembolus, an internal carotid artery occlusion has been present, and in whom angioplasty of these totally occluded internal carotid arteries has bee n successful.
Methods:
We reviewed retrospectively our experience in treating a cute stroke patients with intracranial, intraarterial urokinase. Six of 27 patients had internal carotid artery occlusions in addition to middle cerebral artery occlusions. Two patients presented with spontaneous carotid dissections for wh ich no further intervention from the ipsilateral internal carotid artery was attempted. In the remaining four internal carotid artery occlusions secondary to atherosclerotic disease, standard guide wires and catheters were negotiated across the level of the internal carotid artery occlusion, which expedited intracranial catheterization for thrombolysis. Subsequently, angioplasty of the internal carotid artery was performed.
Results:
All four occluded internal carotid arteries could be traversed. No new neurologic deficits occurred. No vascular injuries occurred. No deaths occurred. Four- to 6-month follow-up showed all four internal carotid arteries remained patent.
Conclusion:
In acute occlusions of the internal carotid artery from atherosclerosis, the occluded vessel can sometimes be recanalized with low morbidity. In addition, endovascular access to the intracranial circulation can be expedited by using the recanalized internal carotid artery.