Endovascular Reperfusion for Acute Isolated Cervical Carotid Occlusions: The Concept of "Hemodynamic Thrombectomy".

Autor:	de Castro-Afonso LH; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Nakiri GS; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Moretti Monsignore L; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Dias FA; Division of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Aléssio-Alves FF; Division of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Rezende MT; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Trivelato FP; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Pontes-Neto OM; Division of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Abud DG; Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Jazyk:	angličtina
Zdroj:	Interventional neurology [Interv Neurol] 2020 Feb; Vol. 8 (1), pp. 27-37. Date of Electronic Publication: 2018 Sep 27.
DOI:	10.1159/000493021
Abstrakt:	Background/aims: Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods: Of a consecutive series of 223 patients who were admitted with acute ische-mic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results: The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions: The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries' stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions. Competing Interests: On behalf of all authors, the corresponding author states that there is no conflict of interest. (Copyright © 2018 by S. Karger AG, Basel.)
Databáze:	MEDLINE
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