Abstract 162: Rescue Carotid Stenting To Reestablish Flow In The Middle Cerebral Artery And Anterior Cerebral Artery In Patients Who Present With Acute Ischemic Stroke And Carotid Occlusion

Abstract

Introduction: Acute ischemic stroke due to the occlusion of the internal carotid artery (ICA) is associated with malignant stroke and poor outcome. Without revascularization of ICA, perfusion to the middle cerebral artery (MCA) and anterior cerebral artery (ACA) is not possible. Objective: Objective of our study is to evaluate the technical feasibility of emergent extracranial carotid artery revascularization using stent and to evaluate the impact of stenting in distal cerebral perfusion. Method: From an established stroke database consecutive patients with acute ischemic stroke who underwent emergent extracranial carotid artery stenting and thrombolysis/clot retrieval of the MCA and ACA from July 2007 to December 2008 were enrolled. Patients’ demographics including presenting National Institute of Health Stroke Scale (NIHSS), degree of revascularization, hemorrhagic conversion and 30 days outcome data using Glasgow Outcome Scale (GOS) were collected. Result: Successful ICA stenting was possible in 20/21 (95%) patients. The mean age of patients was 62 plus-minus 15 years and mean NIHSS was 18 plus-minus 5. Carotid stenting facilitated successful revascularization of the MCA and ACA using TPA (tissue plasminogen activator) and MERCI (mechanical embolus removal in cerebral ischemia) clot retriever device in 18 patients (85.7%), 14 (67%) of which has achieved complete recanalization in the MCA and ACA. In complete recanalization group, a 4 point or higher NIHSS improvement was observed in 11/14 (78.5%) patients. Symptomatic intracranial hemorrhage was observed in 9.5% patients. Seven (50%) of 14 patients who achieved complete recanalization had a good outcome. Five (71%) of 7 patients who did not achieve complete recanalazation of the MCA and ACA died and had NIHSS 20 or higher. NIHSS 20 or higher was associated with incomplete recanalization of the MCA and ACA and poor outcome. Conclusion: Emergent extracranial carotid artery revascularization using stent is not only technically feasible in patients with acute ischemic stroke who present with acute carotid artery occlusion, but it also facilitates successful reestablishment of flow in the MCA and ACA with good outcome. Further study is necessary.