Acute extracranial occlusion of the internal carotid artery

carotid artery (eICA) can lead to a critical and potentially
devastating stroke associated with high morbidity and
mortality. Optimal treatment remains unclear. We analyzed
our institutional experience with emergent surgical recanalization
of acutely occluded eICA.
Methods Retrospective analysis of hospital records, surgical
reports, imaging studies and outpatient records. Final outcome
was assessed according to modified Rankin Scale (mRS).
Results Between January 2010 and September 2013, 22 patients
underwent emergent surgical recanalization. There were
17 men and five women, mean age 65.4 years (range 37–85).
Mean admission National Institute of Health Stroke Scale
(NIHSS) was 12 (range 6–21). All patients had evidence of
salvageable penumbra on perfusion computed tomography.
Tandem intracranial lesion was present in nine patients.
Surgical recanalization was successful in 16 patients
(72.7 %). Twenty-four hours after surgery, 17 patients
(77.2 %) improved by a minimum of 1 point on NIHSS, 14
patients (63.6 %) improved by three and more points; two
patients deteriorated by two and five points, the latter treated
initially with systemic thrombolysis due to intracranial hemorrhage.
No other intracranial hematoma was observed.
During 30 days following surgery, two patients died (9 %
mortality rate) due to severity of initial stroke. On discharge,
four patients were classified as mRS 0, five patients as mRS 1,
five patients as mRS 2 and six patients as mRS 4. Favorable
recovery (mRS 0–2) was achieved in 14 patients (63.6 %). No
change in mRS was observed at three months.
Conclusions Our results suggest that emergent surgical
desobliteration of occluded eICA can lead to favorable recovery
in a majority of patients. Patient selection based on penumbra
imaging is crucial. Given the popularity and simplicity
of carotid endarterectomy, the procedure should by no means
be abandoned in the treatment of acute eICA occlusion.