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Acta Neurochirurgica

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01.05.2014 | Clinical Article - Vascular

Acute extracranial occlusion of the internal carotid artery: emergent surgery remains a viable option

verfasst von: Vladimír Beneš 3rd, Pavel Buchvald, Sylva Klimošová, Zuzana Eichlová, Petr Suchomel

Erschienen in: Acta Neurochirurgica | Ausgabe 5/2014

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Abstract

Background

Acute symptomatic occlusion of extracranial internal carotid artery (eICA) can lead to a critical and potentially devastating stroke associated with high morbidity and mortality. Optimal treatment remains unclear. We analyzed our institutional experience with emergent surgical recanalization of acutely occluded eICA.

Methods

Retrospective analysis of hospital records, surgical reports, imaging studies and outpatient records. Final outcome was assessed according to modified Rankin Scale (mRS).

Results

Between January 2010 and September 2013, 22 patients underwent emergent surgical recanalization. There were 17 men and five women, mean age 65.4 years (range 37–85). Mean admission National Institute of Health Stroke Scale (NIHSS) was 12 (range 6–21). All patients had evidence of salvageable penumbra on perfusion computed tomography. Tandem intracranial lesion was present in nine patients. Surgical recanalization was successful in 16 patients (72.7 %). Twenty-four hours after surgery, 17 patients (77.2 %) improved by a minimum of 1 point on NIHSS, 14 patients (63.6 %) improved by three and more points; two patients deteriorated by two and five points, the latter treated initially with systemic thrombolysis due to intracranial hemorrhage. No other intracranial hematoma was observed. During 30 days following surgery, two patients died (9 % mortality rate) due to severity of initial stroke. On discharge, four patients were classified as mRS 0, five patients as mRS 1, five patients as mRS 2 and six patients as mRS 4. Favorable recovery (mRS 0–2) was achieved in 14 patients (63.6 %). No change in mRS was observed at three months.

Conclusions

Our results suggest that emergent surgical desobliteration of occluded eICA can lead to favorable recovery in a majority of patients. Patient selection based on penumbra imaging is crucial. Given the popularity and simplicity of carotid endarterectomy, the procedure should by no means be abandoned in the treatment of acute eICA occlusion.

Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38:1655–1711PubMedCrossRef

Bangalore S, Bhatt DL, Rother J, Alberts MJ, Thornton J, Wolski K, Goto S, Hirsch AT, Smith SC, Aichner FT, Topakian R, Cannon CP, Steg PG (2010) Late outcomes after carotid artery stenting versus carotid endarterectomy: insights from a propensity-matched analysis of the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Circulation 122:1091–1100PubMedCrossRef

Barnett HJ, Eliasziw M, Meldrum HE, Taylor DW (1996) Do the facts and figures warrant a 10-fold increase in the performance of carotid endarterectomy on asymptomatic patients? Neurology 46:603–608PubMedCrossRef

Benes V Jr (1987) Emergency internal carotid artery desobliteration in patients with severe neurological deficit. Zentralbl Neurochir 48:1–8PubMed

Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, Macdonald S, Gaines PA, Waaijer A, Stierli P, Jager HR, Lyrer PA, Kappelle LJ, Wetzel SG, van der Lugt A, Mali WP, Brown MM, van der Worp HB, Engelter ST (2010) New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9:353–362PubMedCrossRef

Bonita R, Beaglehole R (1988) Recovery of motor function after stroke. Stroke 19:1497–1500PubMedCrossRef

CAVATAS (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 357:1729–1737CrossRef

Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003PubMedCentralPubMedCrossRef

Cho YP, Kwon TW, Kwon SU, Chae WY, Kim GE (2011) Carotid endarterectomy for symptomatic complete occlusion of the internal carotid artery. Acta Med Okayama 65:239–245PubMed

10.

Curtze S, Putaala J, Saarela M, Vikatmaa P, Kantonen I, Tatlisumak T (2011) Carotid embolectomy and endarterectomy for symptomatic complete occlusion of the carotid artery as a rescue therapy in acute ischemic stroke. Case Rep Neurol 3:301–308PubMedCentralPubMedCrossRef

11.

Dalyai RT, Chalouhi N, Singhal S, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Ghobrial G, Tjoumakaris SI (2013) Stent-assisted endovascular recanalization of extracranial internal carotid artery occlusion in acute ischemic stroke. World Neurosurg 79:143–148PubMedCrossRef

12.

del Zoppo GJ, Poeck K, Pessin MS, Wolpert SM, Furlan AJ, Ferbert A, Alberts MJ, Zivin JA, Wechsler L, Busse O et al (1992) Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 32:78–86PubMedCrossRef

13.

Economopoulos KJ, Gentile AT, Berman SS (1999) Comparison of carotid endarterectomy using primary closure, patch closure, and eversion techniques. Am J Surg 178:505–510PubMedCrossRef

14.

Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375:985–997PubMedCrossRef

15.

Fischer U, Mono ML, Schroth G, Jung S, Mordasini P, El-Koussy M, Weck A, Brekenfeld C, Findling O, Galimanis A, Heldner MR, Arnold M, Mattle HP, Gralla J (2013) Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol 20:1017–1024PubMedCrossRef

16.

Gonzalez RG (2006) Imaging-guided acute ischemic stroke therapy: from “time is brain” to “physiology is brain”. AJNR Am J Neuroradiol 27:728–735PubMed

17.

Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329PubMedCrossRef

18.

Hernandez-Perez M, Perez de la Ossa N, Aleu A, Millan M, Gomis M, Dorado L, Lopez-Cancio E, Jovin T, Davalos A (2013) Natural history of acute stroke due to occlusion of the middle cerebral artery and intracranial internal carotid artery. J Neuroimaging. doi:10.1111/jon.12062 PubMed

19.

Jansen O, von Kummer R, Forsting M, Hacke W, Sartor K (1995) Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation. AJNR Am J Neuroradiol 16:1977–1986PubMed

20.

Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947PubMedCrossRef

21.

Jovin TG, Gupta R, Uchino K, Jungreis CA, Wechsler LR, Hammer MD, Tayal A, Horowitz MB (2005) Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate. Stroke 36:2426–2430PubMedCrossRef

22.

Kasper GC, Wladis AR, Lohr JM, Roedersheimer LR, Reed RL, Miller TJ, Welling RE (2001) Carotid thromboendarterectomy for recent total occlusion of the internal carotid artery. J Vasc Surg 33:242–249, discussion 249-250PubMedCrossRef

23.

Kwak HS, Hwang SB, Jin GY, Hippe DS, Chung GH (2013) Predictors of functional outcome after emergency carotid artery stenting and intra-arterial thrombolysis for treatment of acute stroke associated with obstruction of the proximal internal carotid artery and tandem downstream occlusion. AJNR Am J Neuroradiol 34:841–846PubMedCrossRef

24.

Lee KY, Han SW, Kim SH, Nam HS, Ahn SW, Kim DJ, Seo SH, Kim DI, Heo JH (2007) Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients. Stroke 38:192–193PubMedCrossRef

25.

Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S, Haley EC, Grotta J, Marler J (1994) Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke 25:2220–2226PubMedCrossRef

26.

Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, Bossavy JP, Denis B, Piquet P, Garnier P, Viader F, Touze E, Julia P, Giroud M, Krause D, Hosseini H, Becquemin JP, Hinzelin G, Houdart E, Henon H, Neau JP, Bracard S, Onnient Y, Padovani R, Chatellier G (2008) Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 7:885–892PubMedCrossRef

27.

Meyer FB, Sundt TM Jr, Piepgras DG, Sandok BA, Forbes G (1986) Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg 203:82–89PubMedCentralPubMedCrossRef

28.

Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2012) Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes. Stroke 43:2362–2368PubMedCrossRef

29.

Molina CA, Montaner J, Arenillas JF, Ribo M, Rubiera M, Alvarez-Sabin J (2004) Differential pattern of tissue plasminogen activator-induced proximal middle cerebral artery recanalization among stroke subtypes. Stroke 35:486–490PubMedCrossRef

30.

Nedeltchev K, Brekenfeld C, Remonda L, Ozdoba C, Do DD, Arnold M, Mattle HP, Schroth G (2005) Internal carotid artery stent implantation in 25 patients with acute stroke: preliminary results. Radiology 237:1029–1037PubMedCrossRef

31.

Paciaroni M, Balucani C, Agnelli G, Caso V, Silvestrelli G, Grotta JC, Demchuk AM, Sohn SI, Orlandi G, Leys D, Pezzini A, Alexandrov AV, Silvestrini M, Fofi L, Barlinn K, Inzitari D, Ferrarese C, Tassi R, Tsivgoulis G, Consoli D, Baldi A, Bovi P, Luda E, Galletti G, Invernizzi P, DeLodovici ML, Corea F, Del Sette M, Monaco S, Marcheselli S, Alberti A, Venti M, Acciarresi M, D’Amore C, Macellari F, Lanari A, Previdi P, Gonzales NR, Pandurengan RK, Vahidy FS, Sline M, Bal SS, Chiti A, Gialdini G, Dumont F, Cordonnier C, Debette S, Padovani A, Cerqua R, Bodechtel U, Kepplinger J, Nesi M, Nencini P, Beretta S, Trentini C, Martini G, Piperidou C, Heliopoulos I, D’Anna S, Cappellari M, Donati E, Bono G, Traverso E, Toni D (2012) Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study. Stroke 43:125–130PubMedCrossRef

32.

Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald IQ, Viera J, Politi M, Korner H, Kostopoulos P, Haass A, Fassbender K, Reith W (2011) Carotid artery stenting in acute stroke. J Am Coll Cardiol 58:2363–2369PubMedCrossRef

33.

Paty PSK, Adeniyi JA, Mehta M, Darling RC, Chang BB, Kreienberg PB, Ozsvath KJ, Roddy SP, Shah DM (2003) Surgical treatment of internal carotid artery occlusion. J Vasc Surg 37:785–788PubMedCrossRef

34.

Pokras R, Dyken ML (1988) Dramatic changes in the performance of endarterectomy for diseases of the extracranial arteries of the head. Stroke 19:1289–1290PubMedCrossRef

35.

Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38:967–973PubMedCrossRef

36.

Rubiera M, Alvarez-Sabin J, Ribo M, Montaner J, Santamarina E, Arenillas JF, Huertas R, Delgado P, Purroy F, Molina CA (2005) Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke. Stroke 36:1452–1456PubMedCrossRef

37.

Rubiera M, Ribo M, Delgado-Mederos R, Santamarina E, Delgado P, Montaner J, Alvarez-Sabin J, Molina CA (2006) Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 37:2301–2305PubMedCrossRef

38.

Seet RS, Wijdicks EM, Rabinstein AA (2012) Stroke from acute cervical internal carotid artery occlusion: treatment results and predictors of outcome. Arch Neurol 69:1615–1620CrossRef

39.

Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, Goldstein LB, Meschia JF, Ferguson RD, Moore WS, Howard G, Brott TG (2011) Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 42:675–680PubMedCentralPubMedCrossRef

40.

Weis-Muller BT, Huber R, Spivak-Dats A, Turowski B, Siebler M, Sandmann W (2008) Symptomatic acute occlusion of the internal carotid artery: reappraisal of urgent vascular reconstruction based on current stroke imaging. J Vasc Surg 47:752–759, discussion 759PubMedCrossRef

Titel: Acute extracranial occlusion of the internal carotid artery: emergent surgery remains a viable option
verfasst von: Vladimír Beneš 3rd
Pavel Buchvald
Sylva Klimošová
Zuzana Eichlová
Petr Suchomel
Publikationsdatum: 01.05.2014
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 5/2014
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-014-2036-6

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Acute extracranial occlusion of the internal carotid artery: emergent surgery remains a viable option

Abstract

Background

Methods

Results

Conclusions

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Neu im Fachgebiet Neurologie

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Update Neurologie

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

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Abstract

Background

Methods

Results

Conclusions

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