Dr. Daniel Kaiser (Dresden / DE), Thanh Ngyuen (Boston, MA / US), Bruce Campbell (Melbourne / AU), Jeffrey Saver (Los Angeles, CA / US), Diederik Dippel (Rotterdam / NL), Andrew Demchuk (Calgary / CA), Charles Majoie (Amsterdam / NL), Peter Mitchell (Melbourne / AU), Johannes Gerber (Dresden / DE), Scott Brown (Mooresville, NC / US), Serge Bracard (Nancy / FR), Francis Guillemin (Nancy / FR), Tudor Jovin (New York, NY / US), Keith Muir (Glasgow / GB), Phil White (Newcastle upon Tyne / GB), Dr. med. Daniela Schöne (Dresden / DE), Michael Hill (Calgary / CA), Mayank Goyal (Calgary / CA), Prof. Dr. med. Volker Pütz (Dresden / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
BACKGROUND: The optimal management of patients with symptomatic isolated internal carotid artery (ICA) occlusion is unknown.
We aimed to assess whether endovascular treatment (EVT) compared with standard medical care was associated with improved
functional outcomes in patients with acute symptomatic isolated intracranial ICA occlusion without involvement of the middle or
anterior cerebral artery, that is, ICA-I occlusion. Additionally, we aimed to compare ICA-I with ICA-L/T occlusion, which involves
the middle and anterior cerebral artery, respectively.
METHODS: We analyzed data from the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials collaboration,
which performed an individual patient data meta-analysis of 7 randomized controlled trials conducted between 2010 and 2017
assessing the benefit of EVT compared to medical management in patients with anterior circulation large vessel occlusion.
We assessed the association between EVT and 90-day good functional outcome (modified Rankin scale scores 0–2), National
Institutes of Health Stroke Scale scores at 24 hours, symptomatic intracranial hemorrhage rates and mortality in patients with
ICA-I and ICA-L/T occlusion.
RESULTS: We included 442 patients with intracranial ICA occlusion, of whom 38 (8.6%) had ICA-I occlusion. In the ICA-I group,
the median age [interquartile range] was 69.5 [61.7–79.5] years, 42.1% were male, and median baseline National Institutes of
Health Stroke Scale was 17 [15–20]. Compared to standard medical care alone, EVT resulted in higher good outcome rates
in patients with ICA-I (42.9% versus 25%; P=0.296) and ICA-L/T occlusion (32.5% versus 14.4%; P<0.001), and significant
improvement in National Institutes of Health Stroke Scale scores at 24 hours. Mortality and symptomatic intracranial hemorrhage
rates were similar between the treatment groups for both occlusion types.
CONCLUSIONS: A minority of patients with intracranial carotid occlusion presented with ICA-I occlusion in the Highly Effective
Reperfusion Evaluated in Multiple Endovascular Stroke Trials population. EVT in patients with ICA-I occlusion and moderate-to-
severe deficit was safe and tended to be similarly effective as compared to patients with ICA-L/T occlusion.