Ralph Rahme1, Todd A Abruzzo, Andrew J Ringer. 1. Department of Neurosurgery, University of Cincinnati, Neuroscience Institute, UC College of Medicine, Cincinnati, Ohio, USA.
Abstract
BACKGROUND: Occlusion of the extracranial internal carotid artery, whether a result of atherothrombosis or dissection, is a challenging cause of ischemic stroke, characterized by a dismal natural history and a poor response to systemic thrombolysis. METHODS: Review of the literature and proposal of a management strategy. RESULTS: In most patients, symptoms are caused by a coexistent intracranial occlusion, and treatment of the latter dictates the final outcome. However, a smaller subset of patients present with acute cerebral hemodynamic insufficiency requiring recanalization of the extracranial vessel. Careful analysis of the initial angiograms, particularly the extent and pattern of collateral flow, will usually give the clue as to the mechanism of stroke. The distal lesion can often be accessed by advancing a microcatheter, either through collateral channels or through the proximal occlusion itself. CONCLUSIONS: In all cases, the importance of prompt and timely recanalization through aggressive intra-arterial therapy cannot be overemphasized.
BACKGROUND: Occlusion of the extracranial internal carotid artery, whether a result of atherothrombosis or dissection, is a challenging cause of ischemic stroke, characterized by a dismal natural history and a poor response to systemic thrombolysis. METHODS: Review of the literature and proposal of a management strategy. RESULTS: In most patients, symptoms are caused by a coexistent intracranial occlusion, and treatment of the latter dictates the final outcome. However, a smaller subset of patients present with acute cerebral hemodynamic insufficiency requiring recanalization of the extracranial vessel. Careful analysis of the initial angiograms, particularly the extent and pattern of collateral flow, will usually give the clue as to the mechanism of stroke. The distal lesion can often be accessed by advancing a microcatheter, either through collateral channels or through the proximal occlusion itself. CONCLUSIONS: In all cases, the importance of prompt and timely recanalization through aggressive intra-arterial therapy cannot be overemphasized.
Authors: Runqi Wangqin; Paul R Krafft; Keaton Piper; Jay Kumar; Kaya Xu; Maxim Mokin; Zeguang Ren Journal: Transl Stroke Res Date: 2019-02-22 Impact factor: 6.829
Authors: Neal M Nolan; Robert W Regenhardt; Matthew J Koch; Scott B Raymond; Christopher J Stapleton; James D Rabinov; Scott B Silverman; Thabele M Leslie-Mazwi; Aman B Patel Journal: J Stroke Cerebrovasc Dis Date: 2020-11-26 Impact factor: 2.136