Clinical Results of Endovascular Treatment for Acute Internal Carotid Artery Occlusion

Recently, endovascular technology such as mechanical thrombectomy has been used for carotid recanalization as a potentially effective treatment option in the acute phase. However, to date, angiographical results and clinical outcome remain unsatisfactory. We report our experience on ten patients treated with endovascular techniques for acute internal carotid artery occlusion. Three patients were given intravenous tissue plasminogen activator therapy before the intervention. The endovascular procedure was carried out under local anesthesia. PTA/stenting was performed in eight patients, suction thrombectomy in four and mechanical thrombectomy using Merci retriever in two. Recanalization was successful (TICI grade 2B–3) in four of the 10 patients (40%). In four of six patients (60%) with the occlusion caused by atherosclerotic stenosis, recanalization was achieved. Only two patients (20%) had a favorable outcome (modified Rankin Scale score 0–2) at discharge, and the mortality rate was 40%. There were three procedure-related complications, two distal embolisms and one hematoma at the puncture site. Patients with internal carotid artery occlusion caused by atherosclerosis benefitted more from the endovascular treatment than those whose occlusion was caused by cardiac embolism. Our case series suggest that in patients with an acute internal carotid artery occlusion, particularly caused by atherosclerotic stenosis, endovascular treatment may be associated with recanalization and neurological improvement.