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Abstract

We thank Dr Kao very much for his interesting comment. Indeed, his series of 30 chronic carotid occlusions reopened by endovascular technique1Kao H.L. Lin M.S. Wang C.S. Lin Y.H. Lin L.C. Chao C.L. et al.Feasibility of endovascular recanalization for symptomatic cervical internal carotid artery occlusion.J Am Coll Cardiol. 2007; 49: 765-771Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar cannot be compared with our series of 35 acute carotid occlusions reopened surgically.2Weis-Müller B.T. Huber R. Spivak-Dats A. Turowski B. Siebler M. Sandmann W. Symptomatic acute occlusion of the internal carotid artery: reappraisal of urgent vascular reconstruction based on current stroke imaging.J Vasc Surg. 2008; 47 (discussion 759): 752-759Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar After reading his article, we misinterpreted his series of carotid occlusions “acute” because time interval elapsed after carotid occlusion was not defined precisely. In the section “patient selection,” he wrote: “the most recent cerebral infarction, if documented, should be at least 2 weeks before intervention.” We concluded that his strategy is to wait 2 weeks after symptomatic carotid occlusion before starting with his intervention. Now we understand that his indication for intervention is different from ours. His intention is to treat recurrent neurological symptoms caused by chronic carotid occlusion. On the contrary, we want to reopen acutely occluded carotid arteries to safe brain from enlarging infarction and to prevent neurologic disturbances caused by carotid occlusion. Until recently, it was not generally accepted that reopening a chronically occluded internal carotid artery (ICA) is a safe way of enhancing cerebral perfusion, but his results show that endovascular technique may change the dogma. However, our approach is designed to take care for the acute stroke patient as early as possible after acute ICA occlusion in order to prevent the patient from chronic occlusion and further sequelae. Regarding “Symptomatic acute occlusion of the internal carotid artery: Reappraisal of urgent vascular reconstruction based on current stroke imaging”Journal of Vascular SurgeryVol. 49Issue 1PreviewWeis-Müller et al reported a single-center experience with surgical revascularization of acute extracranial internal carotid artery (ICA) occlusion in the acute stage.1 In the Discussion section, they cited our previous article2 and stated “Nowadays interventional teams are also dealing with acute ICA occlusion. The largest series was actually presented by a Taiwanese group, who treated 30 patients with acute cervical ICA occlusion by using endovascular techniques.” After comparing with our results, they concluded that it is better to treat cervical ICA occlusion surgically. Full-Text PDF Open Archive