J Korean Soc Radiol.  2013 Aug;69(2):93-98. 10.3348/jksr.2013.69.2.93.

Outcomes of Emergent Carotid Artery Stenting within 6 Hours of Symptom Onset in Patients with Acute Ischemic Stroke

• Jeong WG
• Yoon W
• Yim NY
• Jung MY
• Jung SH
• Kang HK

• KMID: 2208811
• DOI: http://doi.org/10.3348/jksr.2013.69.2.93

Abstract

PURPOSE
To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke.
MATERIALS AND METHODS
Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions.
RESULTS
Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months.
CONCLUSION
Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

MeSH Terms

Carotid Arteries
Carotid Artery, Internal
Cerebral Hemorrhage
Cohort Studies
Humans
Stents
Stroke

Figure

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  Fig. 1 Brain images from a 69-year-old man with acute ischemic stroke. His NIHSS score was 18 at admission. A. Axial diffusion-weighted image shows acute infarctions involving left basal ganglia and left frontal operculum. B. MTT map of perfusion MRI shows large ischemic penumbra in whole left MCA territory. C. Left common carotid angiogram shows complete occlusion at proximal cervical portion of left internal carotid artery. D. Left common carotid angiogram obtained after carotid artery stenting shows successful recanalization of occluded left internal carotid artery. E. Left carotid angiogram obtained after carotid artery stenting reveals tandem occlusion at proximal M1 segment of left middle cerebral artery. F. Left carotid angiogram after mechanical thrombectomy with Solitaire stent shows complete recanalization and reperfusion of left middle cerebral artery. G. Photograph shows clot retrieved by the Solitaire stent. NIHSS at discharge was 7. His mRS score was 2 at 3 months. Note.-MCA = middle cerebral artery, mRS = modified Rankin Scale, MTT = mean transit time, NIHSS = National Institutes of Health Stroke Scale

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