Acute ischemic stroke attributable to extracranial internal carotid artery (ICA) occlusion is frequently associated with severe disability or death.
In selected cases, re-vascularization with carotid artery stenting has been reported, but the safety, re-canalization rate, and clinical outcomes in consecutive case series are not known.
Stenting is a procedure in which a balloon-tipped catheter is inserted into an artery and advanced to the point of the blockage. The balloon is then inflated to open the artery, and a stent is put in place to keep the artery open.
Stenting is commonly used for strokes caused by partial blockage of a carotid artery, which carries blood to the brain. But there had not been much research on whether it would work for complete artery blockage.
A recent study, published in the October issue of the journal Stroke reviewed cases of ICA occlusions that underwent cerebral angiography with the intent to revascularize over a 38-month period. Two groups were identified: patients who presented with an acute clinical presentation within 6 hours of symptom onset; and patients who presented subacutely with neurologic fluctuations because of the ICA occlusion.
Out of a total of 25 patients, 23 (92%) were successfully revascularized with carotid artery stenting. Only two clinically insignificant adverse events were noted: one asymptomatic hemorrhage and one nonflow-limiting dissection.
The authors state that endovascular treatment of acute ICA occlusion appears to have a high-recanalization rate and is relatively safe in patients with acute ICA occlusion. However, future prospective studies are necessary to determine which patients are most likely to benefit from this form of therapy. The study suggests that this approach is feasible, and sets the stage for a larger, controlled trial to show whether stenting for such patients gives long-term benefits.