Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery.
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| Title: | Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. |
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| Authors: | Fischer, U., Mono, M. ‐ L., Schroth, G., Jung, S., Mordasini, P., El ‐ Koussy, M., Weck, A., Brekenfeld, C., Findling, O., Galimanis, A., Heldner, M. R., Arnold, M., Mattle, H. P., Gralla, J. |
| Source: | European Journal of Neurology. Jul2013, Vol. 20 Issue 7, p1017-1024. 9p. 3 Diagrams, 3 Charts. |
| Subjects: | Carotid artery diseases, Endovascular surgery, Thrombolytic therapy, Cerebral arteries, Intracranial aneurysms, Hemorrhage |
| Abstract: | Background and purpose Endovascular therapy is used increasingly for treatment of acute symptomatic internal carotid artery ( ICA) occlusion, although randomized trials are lacking. Predictors of outcome are therefore of special interest. Methods From 1992 to 2010 we treated 201 patients with acute ICA occlusion with intra-arterial pharmacological thrombolysis (32), endovascular mechanical therapy (78) or a combination of both (91). All data were assessed prospectively. Results There were 76/38% patients with tandem occlusions [ ICA plus middle ( MCA) or anterior cerebral arteries ( ACA)], 18/9% without concomitant occlusions of major intracranial arteries ( ICA plus branch occlusion) and 107/53% with functional ICA- T occlusions ( ICA plus MCA and ACA). Median baseline National Institute of Health Stroke Scale ( NIHSS) score was 17. Good recanalization ( Thrombolysis in Myocardial Infarction 2-3) was achieved in (157/201) 78% patients and good reperfusion ( Thrombolysis in Cerebral Infarction 2-3) in (151/182) 83%. Better recanalization rates were obtained with mechanical approaches, with/without thrombolytics (78/91 = 86% and 64/78 = 82%) compared with pharmacological thrombolysis only (15/32 = 47%; P < 0.001). Twelve patients (6%) suffered symptomatic intracranial haemorrhages. The 3-month outcome was favourable [modified Rankin score ( mRS) 0-2] in 54/28% patients and moderate ( mRS 0-3) in 90/46%; 60/31% patients died. Only 17/16% patients with functional ICA- T occlusions had favourable outcomes compared with 32/44% with tandem occlusions and 5/31% with ICA plus cerebral branch occlusions ( P = 0.001). In multivariate analysis age [odds ratio ( OR) = 0.96, 95% confidence interval ( CI) = 0.93-0.98], NIHSS on admission ( OR = 0.9, 95% CI = 0.83-0.98) and functional ICA- T occlusion ( OR = 0.35, 95% CI = 0.16-0.77) were non-modifiable predictors, and vessel recanalization was the only modifiable predictor of outcome ( OR = 9.30, 95% CI = 2.03-42.63). Conclusions The outcome of acute symptomatic ICA occlusion is poor. However, recanalization is associated with better outcome, and recanalization rates with mechanical techniques were superior to merely pharmacological recanalization attempts. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background and purpose Endovascular therapy is used increasingly for treatment of acute symptomatic internal carotid artery ( ICA) occlusion, although randomized trials are lacking. Predictors of outcome are therefore of special interest. Methods From 1992 to 2010 we treated 201 patients with acute ICA occlusion with intra-arterial pharmacological thrombolysis (32), endovascular mechanical therapy (78) or a combination of both (91). All data were assessed prospectively. Results There were 76/38% patients with tandem occlusions [ ICA plus middle ( MCA) or anterior cerebral arteries ( ACA)], 18/9% without concomitant occlusions of major intracranial arteries ( ICA plus branch occlusion) and 107/53% with functional ICA- T occlusions ( ICA plus MCA and ACA). Median baseline National Institute of Health Stroke Scale ( NIHSS) score was 17. Good recanalization ( Thrombolysis in Myocardial Infarction 2-3) was achieved in (157/201) 78% patients and good reperfusion ( Thrombolysis in Cerebral Infarction 2-3) in (151/182) 83%. Better recanalization rates were obtained with mechanical approaches, with/without thrombolytics (78/91 = 86% and 64/78 = 82%) compared with pharmacological thrombolysis only (15/32 = 47%; P < 0.001). Twelve patients (6%) suffered symptomatic intracranial haemorrhages. The 3-month outcome was favourable [modified Rankin score ( mRS) 0-2] in 54/28% patients and moderate ( mRS 0-3) in 90/46%; 60/31% patients died. Only 17/16% patients with functional ICA- T occlusions had favourable outcomes compared with 32/44% with tandem occlusions and 5/31% with ICA plus cerebral branch occlusions ( P = 0.001). In multivariate analysis age [odds ratio ( OR) = 0.96, 95% confidence interval ( CI) = 0.93-0.98], NIHSS on admission ( OR = 0.9, 95% CI = 0.83-0.98) and functional ICA- T occlusion ( OR = 0.35, 95% CI = 0.16-0.77) were non-modifiable predictors, and vessel recanalization was the only modifiable predictor of outcome ( OR = 9.30, 95% CI = 2.03-42.63). Conclusions The outcome of acute symptomatic ICA occlusion is poor. However, recanalization is associated with better outcome, and recanalization rates with mechanical techniques were superior to merely pharmacological recanalization attempts. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 13515101 |
| DOI: | 10.1111/ene.12094 |
