Recanalization therapy for internal carotid artery occlusion presenting as acute ischemic stroke.
BACKGROUND
We aimed to describe the current status and clinical outcomes of recanalization therapy for internal carotid artery occlusion (ICAO) presenting as acute ischemic stroke.


METHODS
Using a nationwide stroke registry database in Korea, we identified consecutive ischemic stroke patients with ICAO hospitalized within 12 hours of onset between March 2010 and November 2011.


RESULTS
ICAO accounted for 10.6% (322 of 3028) of acute ischemic strokes within 12 hours of onset. Among the 322 ICAO patients, 53% underwent recanalization therapy, 41% intravenous thrombolysis (IVT) alone, and 59% endovascular treatment (EVT). Twenty-two percent of those with mild deficits (National Institutes of Health Stroke Scale <4) and 50% of those 80 years of age or more received recanalization therapy. Compared with no treatment, recanalization therapy was not significantly associated with a favorable outcome (3-month modified Rankin scale, 0-2) (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], .80-3.91; P = .16). However, compared with IVT, EVT significantly improved the odds of favorable outcome (OR, 2.86; 95% CI, 1.19-6.88; P = .02) without significant increase of symptomatic intracranial hemorrhage (OR, 2.18; 95% CI, .42-11.43; P = .36) and 3-month mortality (OR, .53; 95% CI, .23-1.18; P = .12). Successful recanalization rate (Thrombolysis in Cerebral Infarction ≥2a) by EVT was 76%.


CONCLUSIONS
In Korea, one tenth of acute ischemic stroke was caused by ICAO, and about 50% were treated by recanalization therapy. EVT was widely used as a recanalization modality (about 60% of cases) despite lack of evidence. However, its effectiveness and safety were acceptable.
['Hong|Jeong-Ho|JH|', 'Kang|Jihoon|J|', 'Jang|Min Uk|MU|', 'Kim|Beom Joon|BJ|', 'Han|Moon-Ku|MK|', 'Park|Tai Hwan|TH|', 'Park|Sang-Soon|SS|', 'Lee|Kyung Bok|KB|', 'Lee|Byung-Chul|BC|', 'Yu|Kyung-Ho|KH|', 'Oh|Mi Sun|MS|', 'Cha|Jae Kwan|JK|', 'Kim|Dae-Hyun|DH|', 'Lee|Jun|J|', 'Lee|Soo Joo|SJ|', 'Ko|Youngchai|Y|', 'Park|Jong-Moo|JM|', 'Kang|Kyusik|K|', 'Cho|Yong-Jin|YJ|', 'Hong|Keun-Sik|KS|', 'Cho|Ki-Hyun|KH|', 'Kim|Joon-Tae|JT|', 'Lee|Juneyoung|J|', 'Lee|Ji Sung|JS|', 'Bae|Hee-Joon|HJ|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000792:Angiography D002343:Carotid Artery, Internal D016893:Carotid Stenosis D057510:Endovascular Procedures D005260:Female D005343:Fibrinolytic Agents D006801:Humans D008297:Male D008875:Middle Aged D056910:Republic of Korea D020521:Stroke D015912:Thrombolytic Therapy D013997:Time Factors D016896:Treatment Outcome
carotid artery thrombolysis Endovascular recanalization acute stroke revascularization