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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.
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]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Fischer%2C+U%2E%22&quot;&gt;Fischer, U.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mono%2C+M%2E+‐+L%2E%22&quot;&gt;Mono, M. ‐ L.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Schroth%2C+G%2E%22&quot;&gt;Schroth, G.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jung%2C+S%2E%22&quot;&gt;Jung, S.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mordasini%2C+P%2E%22&quot;&gt;Mordasini, P.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22El+‐+Koussy%2C+M%2E%22&quot;&gt;El ‐ Koussy, M.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Weck%2C+A%2E%22&quot;&gt;Weck, A.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Brekenfeld%2C+C%2E%22&quot;&gt;Brekenfeld, C.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Findling%2C+O%2E%22&quot;&gt;Findling, O.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Galimanis%2C+A%2E%22&quot;&gt;Galimanis, A.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Heldner%2C+M%2E+R%2E%22&quot;&gt;Heldner, M. R.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Arnold%2C+M%2E%22&quot;&gt;Arnold, M.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mattle%2C+H%2E+P%2E%22&quot;&gt;Mattle, H. P.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gralla%2C+J%2E%22&quot;&gt;Gralla, J.&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Journal+of+Neurology%22&quot;&gt;European Journal of Neurology&lt;/searchLink&gt;. Jul2013, Vol. 20 Issue 7, p1017-1024. 9p. 3 Diagrams, 3 Charts.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Carotid+artery+diseases%22&quot;&gt;Carotid artery diseases&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Endovascular+surgery%22&quot;&gt;Endovascular surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Thrombolytic+therapy%22&quot;&gt;Thrombolytic therapy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cerebral+arteries%22&quot;&gt;Cerebral arteries&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Intracranial+aneurysms%22&quot;&gt;Intracranial aneurysms&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Hemorrhage%22&quot;&gt;Hemorrhage&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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 &lt; 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]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/ene.12094
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        Text: English
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        PageCount: 9
        StartPage: 1017
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      – SubjectFull: Carotid artery diseases
        Type: general
      – SubjectFull: Endovascular surgery
        Type: general
      – SubjectFull: Thrombolytic therapy
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      – SubjectFull: Cerebral arteries
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      – SubjectFull: Intracranial aneurysms
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      – SubjectFull: Hemorrhage
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              Text: Jul2013
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