Clot Removal Therapy by Aspiration and Extraction for Acute Embolic Carotid Occlusion

Abstract

BACKGROUND AND PURPOSE: The purpose of our retrospective study was to investigate the feasibility, safety, and efficacy of clot removal therapy by aspiration and extraction for patients with acute stroke with embolic internal carotid artery (ICA) occlusion. METHODS: Of 814 consecutive patients with acute ischemic stroke admitted to our institution from March 2003 to April 2005, clot removal therapy was performed for 14. Inclusion criteria were patients (1) presenting within 6 hours of onset of cardioembolic stroke, (2) with serious neurologic symptoms defined by a National Institutes of Health Stroke Scale (NIHSS) score of at least 11, (3) without extensive high signal intensity on diffusion-weighted MR images but with decreased ipsilateral hemispheric cerebral blood flow on perfusion-weighted images (perfusion/diffusion mismatch), and (4) with total ICA occlusion on angiograms. We removed clots by aspiration and extraction with a microsnare through either a guiding or balloon guide catheter. Radiographic results, 7-day NIHSS, 3-month modified Rankin Scale, and procedure-related complications were evaluated. RESULTS: Of 10 patients treated with the balloon guide catheter to temporarily interrupt proximal flow, 7 obtained complete or partial recanalization. The 4 patients treated with the guiding catheter had no recanalization. Of the 7 patients with recanalization, 6 had favorable 7-day neurologic and 3-month functional outcome; all showed anatomic crossflow via the anterior communicating artery. A procedure-related complication, distal embolization into the ipsilateral anterior cerebral artery, occurred in 1 patient. CONCLUSION: Balloon guide catheter-assisted clot removal therapy for embolic ICA occlusion may provide a high recanalization rate and good clinical outcome in patients with anatomic crossflow.