Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients

• Published in: Clinical neuroradiology (Munich) 2016-03, Vol.26 (1), p.23-29
• Main Authors: Frahm, Daniela, Wunderlich, Silke, Schubert, Mirjam I., Poppert, Holger, Kleine, Justus F., Prothmann, Sascha
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Care and treatment; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - prevention & control; Clinical outcomes; Computed Tomography Angiography - methods; Female; Health aspects; Humans; Ischemia; Male; Mechanical Thrombolysis - adverse effects; Mechanical Thrombolysis - methods; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Neurology; Neuroradiology; Neurosurgery; Original Article; Radiography, Interventional - methods; Retrospective Studies; Stroke (Disease); Surgery, Computer-Assisted - methods; Treatment Outcome; Young Adult
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-014-0322-6

Background and Purpose Acute occlusion of the carotid-T is associated with large ischemic lesions, poor outcome and up to 53 % mortality with conservative therapy. Endovascular mechanical thrombectomy (EMT) is a promising alternative treatment of large vessel occlusion. Here, we examine feasibility, safety and efficiency of EMT in acute ischemic stroke due to carotid-T-occlusion. Methods Single centre, retrospective analysis of 51 consecutive patients with acute occlusion of the carotid-T, treated by EMT within 6 h after symptom onset. Most patients (42/51) were treated with stentretrievers, 33 with stentretrievers only. Recanalization was assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Early and mid-term clinical outcome was evaluated by National Institutes of Health Stroke Scale (NIHSS)- and modified Rankin Scale mRS-scores, respectively. Results Successful recanalization (TICI 2b/3) was achieved in 78.4 % (40/51). Good clinical outcome (mRS 0–2) was observed in 24.4 % of patients, and only in patients treated successfully (TICI 2b/3). Stentretrievers yielded higher recanalization rates and better clinical outcomes than non-stentretriever devices. A total of 12 patients died (29.3 %) during the 90-day observation period. Clinically relevant procedure-related complications occurred in two patients, consisting in one vessel perforation with a microwire, and one symptomatic parenchymal haemorrhage after initiation of antiplatelet therapy following the inadvertent detachment of a stentretriever. Another symptomatic haemorrhage, not directly procedure-related, occurred in one additional patient. Conclusion EMT in acute carotid-T-occlusion is efficient, yielding high recanalization rates, and reasonably safe, with a low rate of clinically relevant complications. Successful recanalization seems to be a prerequisite for good clinical outcome in this severe condition.