J Korean Soc Radiol.  2015 Oct;73(4):230-239. 10.3348/jksr.2015.73.4.230.

Intra-Arterial Therapy for Cardioembolic Internal Carotid Artery Terminus Occlusion: The Past and Present Status in Real Practice

• Jung S
• Jung C
• Kim JH
• Choi BS
• Kim BJ
• Han MK
• Bae HJ
• Kwon BJ
• Cha SH

• KMID: 2068713
• DOI: http://doi.org/10.3348/jksr.2015.73.4.230

Abstract

PURPOSE
There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT.
MATERIALS AND METHODS
On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared.
RESULTS
Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis.
CONCLUSION
Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

MeSH Terms

Carotid Artery, Internal*
Cerebral Infarction
Endovascular Procedures
Groin
Humans
Prognosis
Punctures
Reperfusion
Retrospective Studies
Stroke
Thrombectomy
Thrombolytic Therapy

Figure

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  Fig. 1 Flow sheet showing the study design and patient exclusion criteria. ICA = internal carotid artery, LNT = last normal time, MERT = multimodal endovascular revascularization therapy, mRS = modified Rankin Scale, NIHSS = National Institutes of Health Stroke Scale

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  Fig. 2 Modified Rankin Scale score at 3 months. IAT = intra-arterial therapy, TEG = thrombectomy-based IAT group, TLG = thrombolytic-based IAT group

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  Fig. 3 Receiver operating characteristic curves of scoring of Alberta Stroke Programme Early CT Score (ASPECTS) using diffusion-weighted imaging or cerebral blood volume map on perfusion CT for predicting unfavorable outcome (mRS ≥ 3) at 3 months (A) and distribution of functional dependency at 3 months according to the baseline ASPECTS ≥ 5 or < 5 (B). AUC = area under the curve, mRS = modified Rankin Scale

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