Journal List > J Korean Soc Radiol > v.69(2) > 1087351

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Jeong, Yoon, Yim, Jung, Jung, and Kang: Outcomes of Emergent Carotid Artery Stenting within 6 Hours of Symptom Onset in Patients with Acute Ischemic Stroke
Neuroradiology

Journal of the Korean Society of Radiology 2013; 69(2): 93-98.

Published online: 9 August 2013

DOI: https://doi.org/10.3348/jksr.2013.69.2.93

Outcomes of Emergent Carotid Artery Stenting within 6 Hours of Symptom Onset in Patients with Acute Ischemic Stroke

Won Gi Jeong, MD, Woong Yoon, MD, Nam Yeol Yim, MD, Min Young Jung, MD, Se Hee Jung, MD, Heoung Keun Kang, MD

Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author: Woong Yoon, MD. Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel. 82-62-220-5746 Fax. 82-62-226-4380, radyoon@jnu.ac.kr

Received 3 April 2013       Accepted 19 May 2013

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke.

Materials and Methods

Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions.

Results

Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months.

Conclusion

Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

Keywords: Acute Stroke, Angioplasty and Stenting, Internal Carotid Artery

Figures and Tables

Fig. 1
Brain images from a 69-year-old man with acute ischemic stroke. His NIHSS score was 18 at admission.
A. Axial diffusion-weighted image shows acute infarctions involving left basal ganglia and left frontal operculum.
B. MTT map of perfusion MRI shows large ischemic penumbra in whole left MCA territory.
C. Left common carotid angiogram shows complete occlusion at proximal cervical portion of left internal carotid artery.
D. Left common carotid angiogram obtained after carotid artery stenting shows successful recanalization of occluded left internal carotid artery.
E. Left carotid angiogram obtained after carotid artery stenting reveals tandem occlusion at proximal M1 segment of left middle cerebral artery.
F. Left carotid angiogram after mechanical thrombectomy with Solitaire stent shows complete recanalization and reperfusion of left middle cerebral artery.
G. Photograph shows clot retrieved by the Solitaire stent. NIHSS at discharge was 7. His mRS score was 2 at 3 months.
Note.-MCA = middle cerebral artery, mRS = modified Rankin Scale, MTT = mean transit time, NIHSS = National Institutes of Health Stroke Scale
jksr-69-93-g001

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