Thrombectomy for acute ischemic stroke patients with isolated distal internal carotid artery occlusion: a retrospective
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INTERVENTIONAL NEURORADIOLOGY
Thrombectomy for acute ischemic stroke patients with isolated distal internal carotid artery occlusion: a retrospective observational study Jan W. Hoving 1 & Manon Kappelhof 1,2 & Mark Schembri 1 & Bart J. Emmer 1 & Olvert A. Berkhemer 1 & Adrien E. D. Groot 3 & Diederik W. J. Dippel 4 & Wim H. van Zwam 5 & Jonathan M. Coutinho 3 & Henk A. Marquering 1,2 & Charles B. L. M. Majoie 1 & René van den Berg 1 & for the MR CLEAN Registry Investigators Received: 15 May 2020 / Accepted: 6 September 2020 # The Author(s) 2020
Abstract Purpose Acute stroke patients presenting with a distal internal carotid artery occlusion and patent carotid terminus, allowing for collateral flow via the circle of Willis, may have a more favorable natural history. Therefore, benefit of endovascular treatment (EVT) is less evident. We performed an exploratory analysis of EVT results compared to conservative treatment in patients with ‘carotid-I’ occlusions. Methods We report on EVT-treated and non-EVT-treated patients with carotid-I occlusions from the MR CLEAN Registry, MR CLEAN trial, and our comprehensive stroke center. CT-angiography was reviewed on primary collateral patency and choroid plexus enhancement. Perfusion deficits were assessed on CT-perfusion (CTP). Clot migration was assessed by comparing clot location on baseline CTA to its location on periprocedural digital subtraction angiography. Outcomes included 90-day functional independence (mRS 0–2), successful reperfusion and mortality. Results We included 51 patients. Forty-one patients received EVT, ten patients did not. Intravenous thrombolysis was administered in 32 (78%) EVT-treated patients and 6 (60%) non-EVT-treated patients. CTP, available for 17 patients, showed hypoperfusion on cerebral blood flow maps in 13 (76%) patients. Successful reperfusion after EVT occurred in 23 (56%), and clot migration in 8 patients (20%). Functional independence was achieved in 54% (21/39) of EVT-treated and in 10% (1/10) of non-EVT-treated patients. Mortality was 26% (10/39) and 30% (3/10), respectively. Anterior choroidal artery patency and choroid plexus enhancement were positively associated with functional independence. Conclusion In our population, data suggest improved outcomes after EVT in carotid-I occlusion patients and provide no arguments to withhold EVT in these patients. Keywords Stroke . Artery . Thrombectomy . CT angiography JWH and MK contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02550-5) contains supplementary material, which is available to authorized users. * René van den Berg [email protected] 1
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
2
Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
4
Department of Neurol
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