This Article Full Text Full Text (PDF) All Versions of this Article: 36/11/2335    most recent 01.STR.0000185930.45475.05v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Qureshi, A. I. Search for Related Content PubMed PubMed Citation Articles by Qureshi, A. I. Related Collections Related Article

(Stroke. 2005;36:2335.)
© 2005 American Heart Association, Inc.

Editorials

Endovascular Revascularization of Symptomatic Acute Extracranial Internal Carotid Artery Occlusion

Adnan I. Qureshi, MD

From the Zeenat Qureshi Stroke Research Center, University of Medicine and Dentistry of New Jersey, Newark.

Correspondence to Adnan I. Qureshi, MD, 90 Bergen St, DOC –8100, Newark, NJ 07103. E-mail aiqureshi@hotmail.com

Key Words: carotid artery occlusion • stent placement • acute ischemic stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 2426–2430.

Acute extracranial internal carotid artery (ICA) occlusion resulting in ischemic stroke is different from other forms of acute occlusion of the cerebral blood vessels. The occluded segment of the ICA consists of predominantly atherosclerotic plaque and a superimposed thrombus. The occluded segments in other cerebral blood vessels, such as the middle cerebral artery, usually consist of an occlusive embolus in a normal vessel.¹ Therefore, the pathophysiologic processes involved in the occlusion of the extracranial ICA are similar to processes observed in acute occlusion of the coronary arteries. In acute myocardial infarction, primary stent placement has provided the best treatment outcomes.² The present report provides early evidence to expand this approach to other occlusions, such as the ICA, where large contributions of atherosclerotic plaque and platelet activation do not provide an ideal substrate for thrombolytics alone.¹

There are 2 important factors that play a role in the technical success of the procedure. The channel with the fresh thrombus can provide a conduit for the wire and stent to traverse the lesion. Therefore, the lesion needs to be traversed before organization of the thrombus. This creates almost a time window for successful revascularization of the ICA occlusion. It should be noted that there is frequently an additional distal occlusion of the internal carotid artery, particularly in the supraclinoid segment, resulting from embolization or propagation of thrombus. This issue can limit the therapeutic value of the procedure despite achieving cervical ICA revascularization. Therefore, visualization to confirm patency . . . [Full Text of this Article]

Related Article:

Emergent Stenting of Extracranial Internal Carotid Artery Occlusion in Acute Stroke Has a High Revascularization Rate

Tudor G. Jovin, Rishi Gupta, Ken Uchino, Charles A. Jungreis, Lawrence R. Wechsler, Maxim D. Hammer, Ashis Tayal, and Michael B. Horowitz
Stroke 2005 36: 2426-2430. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				D.C. Suh, J.K. Kim, C.G. Choi, S.J. Kim, H.W. Pyun, C. Ahn, D.H. Yang, K.S. Lim, J.-G. Leem, K.D. Hahm, et al. Prognostic Factors for Neurologic Outcome after Endovascular Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1167 - 1171. [Abstract] [Full Text] [PDF]