Acute ischemic stroke due to internal carotid occlusion: effect of occlusion type on prognosis (2023)


For the initial diagnosis of acute ischemic stroke (AIS), computed tomography angiography (CTA) is usually performed to detect and localize large vessel occlusions (LVOs). CTA allows physicians to detect and localize the site of occlusion, which can provide the necessary information for appropriate treatment planning, especially for selecting potential candidates for mechanical thrombectomy (MT). In addition, it provides information on the status of collateral,1,2This is the main prognostic feature after MT in patients with AIS.

The internal carotid artery (ICA) is one of the common and important sites of LVO in patients with AIS. AIS due to ICA occlusion also has a different pathophysiology due to the heterogeneous entity of AIS. Although classification of AIS with LVO based on etiology may suggest a different clinical course and outcome,3In a large number of patients, the etiology is unknown. In contrast, classification based on the site of occlusion may be simpler and more relevant in the current era of MT. However, few studies have compared the clinical and prognostic aspects after MT according to the type of ICA occlusion.4

ICA occlusion in AIS can be divided into internal carotid (cICA) occlusion and distal ICA (dICA) occlusion. An interesting entity is cICA pseudoocclusion. Although the actual occlusion occurs in the dICA, it appears similar to cICA occlusion due to contrast flow obstruction due to dICA occlusion.5Therefore, AIS with ICA occlusion can be divided into 3 categories: (1) true cICA occlusion, (2) cICA pseudoocclusion, and (3) dICA occlusion (Figure 1). We recently identified clinical and prognostic differences according to the type of ICA occlusion,5We hypothesized that there might be pathophysiological differences between the 3 types of ICA occlusion. This study aimed to compare the clinical outcomes of AIS patients with ICA occlusion after MT, focusing on the type of ICA occlusion.

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research population

From January 2009 to December 2020, a total of 264 consecutive patients with AIS were treated with MT in a tertiary center. Patients were considered eligible if they met the following inclusion criteria: (1) AIS with ICA occlusion on CTA, (2) type of occlusion confirmed by catheter angiography, (3) MT with stent retriever, suction device and/or carotid balloon angioplasty, with/ without a stent. We excluded (1) AIS involving non-ICA sites (n=180), (2) MT using any thrombectomy


Among the 67 patients, there were 14 cases of true occlusion, 32 cases of pseudoocclusion and 21 cases of dICA occlusion. Baseline NIHSS score for pseudoocclusion (median and interquartile range [IQR] 16 [12–21],Pi= 0.004) were significantly higher than true occlusions (11 [7.5–13.5]) or dICA occlusions (13 [10.5–15.5]). The primary etiology differed significantly between the 3 groups (64.3% atherothrombosis in true occlusion, 81.3% and 71.4% cardiac embolism in pseudoocclusion and dICA


This study showed that sham occlusions showed lower reperfusion rates and larger infarct volumes after MT compared with other types of ICA occlusions and had worse functional outcomes at 90 days. Pseudoocclusion is not only a diagnostic challenge, but also has a clinical effect on the functional outcome and reperfusion status of AIS with ICA occlusion after MT.

Poorer results of pseudoocclusions may be related to their clinicopathological characteristics, including the site of occlusion

CrediT Author Contribution Statement

Kim Hee Jang:First author, research, writing - manuscript, project development.Zheng Guoli:Research, project development.Guo Jiacheng:Research, project development.Kim Bum Soo:Research, project development.Yong Sam Shin:Research, project development.He Hecai:Corresponding author, project development, research, writing - manuscript.

Featured Articles (6)

  • research article

    (Video) Ischemic Stroke - causes, symptoms, diagnosis, treatment, pathology

    Clinical significance of emergency liver transplantation from a deceased donor in a patient with persistent left superior vena cava thrombosis: case report

    Proceedings of the Conference on Transplantation, Volume 54, Number 6, 2022, Pages 1648-1653

    Persistent left superior vena cava (PLSVC) is the most common congenital venous malformation of the chest. It is usually discovered accidentally during an examination or invasive procedure. In most cases, blood flows from the coronary sinus into the right atrium without hemodynamic abnormalities and is usually asymptomatic. There is some controversy regarding the clinical use of PLSVC. In a few cases, PLSVC has been used for hemodialysis or access to large veins.

    A 62-year-old woman developed liver failure after hepatectomy for hepatocellular carcinoma and cirrhosis. As her condition worsened, she needed a liver transplant (LT). However, preoperative transesophageal echocardiography revealed a superior vena cava thrombus between the right atrium and the proximal superior vena cava. Typically, right central catheterization is prepared for LT, but the risk of embolism in our patient was very high. Fortunately, he had already been diagnosed with PLSVC. Therefore, we decided to perform fluoroscopically guided catheterization through the PLSVC. For the safe use of the PLSVC catheter during surgery, pressure in the rapid infusion system, coronary sinus inlet pressure, and intraoperative transesophageal echocardiography were monitored. The patient successfully underwent LT.

    Combining the literature review and this case, PLSVC can be used clinically under the condition of detailed medical history, preoperative imaging and careful intraoperative monitoring. We suggest that PLSVC is a viable alternative to LT central venous access.

  • research article

    Extrinsic neurolysis during microvascular decompression of MRI-negative idiopathic trigeminal neuralgia

    World Neurosurgery, Volume 157, 2022, Pages e448-e460

    Internal neurolysis has been proposed as an alternative to microvascular decompression in patients with idiopathic trigeminal neuralgia (TN) in whom neurovascular compression is not confirmed by magnetic resonance imaging (MRI). External neurolysis, which corrects and aligns the axis of the trigeminal nerve root by dissection of the arachnoid nerve around the nerve, was reported 20 years ago in the context of a so-called negative finding when MRI did not confirm the absence of problematic vessels, but is currently not used.

    (Video) Acute Ischemic Stroke: Etiology, Pathophysiology, Clinical Features, Diagnostics, Treatment

    Four patients with idiopathic TN underwent external neurolysis and had typical evoked neuralgia despite the absence of suspected diseased vessels on MRI. Outcomes of the surgical procedure leading to TN were summarized and assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI-PS).

    Pinching and twisting of the nerve root by the surrounding arachnoid is a common occurrence. All 4 patients experienced complete pain relief immediately after surgery. During a follow-up period of 26.5 ± 16.92 months (± SD), 3 of 4 patients were pain-free (score I, BNI-PS). One patient scored IIIa on the BNI-PS assessment. There were no cases of recurrence or side effects related to the surgery.

    Idiopathic TN may be caused by individual differences in the surrounding arachnoid sheath supporting the trigeminal nerve root, a condition not recognized by MRI. Epidural neurolysis can be considered an effective treatment for MRI-negative idiopathic TN.

  • research article

    Direct aspiration thrombectomy as the preferred method in elderly patients with ischemic stroke

    Clinical Neurology and Neurosurgery, Volume 207, 2021, Article 106797

    This study aimed to determine whether age ≥80 years affects the radiological and clinical outcomes of a first-pass direct aspiration strategy for large-vessel occlusions.

    This study analyzed data from a single center of stroke patients treated with mechanical thrombectomy between May 2018 and October 2020. Baseline characteristics as well as radiological and clinical outcomes of elderly patients (≥80 years) were recorded, analyzed and compared. years) and elderly patients (<80 years).

    Sixty patients underwent mechanical thrombectomy using a Sofia suction catheter for occlusion of the main trunk of the middle cerebral artery. The effective rate of the direct first-pass aspiration strategy was 56.3% (n=9) and 54.4% (n=24) respectively in the elderly and non-elderly groups (Pi=0.907). The final success rate of recanalization (thrombolysis for cerebral infarction ≥2b) in the elderly group and in the elderly group was 75.0% (n=12) and 70.5% (n=31) respectively (Pi=0.999). Good 90-day clinical outcome (modified Rankin scale2) (50.0% and 56.8% respectively for the elderly and the elderly,Pi= 0.639). Furthermore, there were no significant differences between groups in complication rates.

    The first-pass direct suction strategy did not differ in recanalization rates and clinical outcomes between patients ≥80 years and <80 years with large-vessel occlusive lesions.

  • research article

    (Video) Stroke Syndromes: MCA, ACA, ICA, PCA, Vertebrobasilar Artery Strokes | Pathophysiology

    Anthropometric analysis of traumatic brain CT results: a retrospective study comparing psoas and abdominal skeletal muscles

    Injury, Vol. 53, No. 5, 2022., str. 1652-1657

    Recent studies have shown that skeletal muscle area (SMA) and psoas muscle area (PMA), as markers of sarcopenia, correlate with prognosis in many diseases. However, it is not clear which of the two is a better prognostic indicator. Therefore, the aim of this study was to analyze these markers in patients with traumatic brain injury (TBI).

    Patients with TBI [Abbreviated Impairment Scale (AIS) score 4 or 5] were selected. Patients with an AIS score of 4 or 5 for thoracic, abdominal, or extremity lesions were excluded. Clinical data including Glasgow Outcome Scale (GOS), mortality and anthropometric data were collected. Measure the SMA and PMA. Calculate the skeletal muscle index (SMI) and psoas index (PMI) for each muscle area divided by the square of the height. The good prognosis group was defined as patients with a GOS score of 4 to 5. The poor prognosis group was defined as patients with a GOS score of 1-3. The total forecast of two sets of data was analyzed. After excluding patients who were hospitalized for 1 or 2 days, the subjects were analyzed to improve prognosis and mortality.

    A total of 212 patients participated in the statistical analysis. Patients with a good prognosis had a larger PMA (17.4 cm2With 15.0 cm2,Pi=0,002) i PMI (6,1 cm2/rice2Contrast 5.3 cm2/rice2,Pi=0.001). After modification, patients with a good prognosis had a larger PMA (17.4 cm2Contrast 14.9 cm2,Pi=0,002) i PMI (6,1 cm2/rice2Contrast 5.3 cm2/rice2,Pi=0.01). In binary logistic regression analysis, PMI was found to be a significant risk factor for prognosis change (odds ratio (OR) (95% confidence interval (CI)): 0.763 (0.633 – 0.921),Pi=0.005) and adjusted mortality (OR (95% CI): 0.740 (0.573 – 0.957),Pi=0,022).

    The psoas minor (PM) muscle was found to be an important risk factor for the prognosis of patients with TBI. PM is a better prognostic marker than skeletal muscle (SM) in patients with TBI. Further research is needed to better understand sarcopenia and TBI.

  • research article

    Elevated D-dimer concentration is a significant independent prognostic factor in patients with acute occlusion of large vessels who underwent endovascular thrombectomy

    World Neurosurgery, Volume 160, 2022, Pages e487-e493

    To study the prognostic factors influencing the modified Rankin scale score 3 months after the onset of acute stroke in patients with large-vessel occlusion undergoing endovascular thrombectomy.

    We retrospectively studied 87 consecutive patients who underwent endovascular cerebral thrombectomy for acute anterior circulation large vessel occlusion at Oita University Hospital and Chotomi Neurosurgery Hospital between January 2014 and December 2020.

    Age, National Institutes of Health Stroke Scale score, and D-dimer intake concentration were significant univariate predictors associated with modified Rankin Scale score 3 months after stroke onset. Multivariate logistic regression analysis showed that D-dimer concentration was the only significant independent predictor. The area under the receiver operating characteristic curve for D-dimer concentration and modified Rankin scale score at 3 months was 0.715 (95% confidence interval 0.599–0.831), using a cutoff of 1.9 µg/mL, sensitivity and specificity were 60, 6% and 80.0% respectively.

    Patients undergoing acute endocerebral thrombectomy with high D-dimer concentrations on admission may have worse outcomes. These patients should consider other treatment options.

    (Video) Acute Ischemic Stroke - Signs and Symptoms (Stroke Syndromes) | Causes & Mechanisms | Treatment
  • research article

    Endovascular thrombectomy for distal middle cerebral artery occlusion: a safe and effective procedure

    World Neurosurgery, Volume 160, 2022, Pages e234-e241

    Distal middle vessel occlusion (DMVO) is increasingly considered the next goal of endovascular thrombectomy (EVT). We aimed to study the safety and clinical outcomes of EVT for middle cerebral artery (MCA) DMVO.

    We analyzed data from the Lille Reperfusion Registry from January 2017 to September 2020. Patients with primary or secondary MCA DMVO identified by angiography before treatment were included. Only patients with an eTICI score of 2b50–2b67 at initial angiography were considered. Baseline characteristics, angiographic clinical outcomes, and safety outcomes were compared in patients who received EVT or standard medical therapy (without EVT).

    Of the 171 patients, 96 underwent EVT (46.9% men, 68.7 ± 15.8 years), and 75 received standard medical therapy (44% men, 73.9 ± 13.1 year). Patients with EVT had better improvement in NIHSS scores at discharge (adjusted mean difference: 3.71, 95% CI: 1.18–6.24). In the distal subgroup with M2 occlusion, EVT was significantly associated with a higher rate of early neurological improvement (adjusted OR: 3.62 95% CI: 1.31-10.03), improvement in NIHSS at discharge (adjusted mean difference: 5 .23, 921% CI: 0.8.29 ) and improved modified Rankin scale score at 3 months (adjusted OR for 1-point improvement: 3.06; 95% CI: 1.30 to 7.23). Symptomatic intracranial bleeding occurred in 3.1% of the group with EVT and 9.5% of the group without EVT.

    EVT in MCA DMVO appears to be safe and may lead to improved clinical outcomes. This effect was particularly pronounced in patients with distal M2 obstruction, so randomized trials are needed to confirm this finding.

© 2022 The Elsevier Company. All rights reserved.

(Video) Endovascular Rx for Acute Carotid Occlusion


What is the prognosis for ICA occlusion? ›

Background: Acute ischemic stroke caused by internal carotid artery (ICA) occlusion usually has a poor prognosis, especially the T occlusion cases without functional collaterals.

What is the prognosis for occlusion stroke? ›

Life-table analysis gave 94% probability for one year's survival, 84% for three years' survival, and 78% for five years' survival. Subsequent strokes were twice as common as cardiovascular events as the cause of death.

What does occlusion of an internal carotid artery mean? ›

Carotid occlusive disease, also called carotid stenosis, is a condition in which one or both of the carotid arteries becomes narrowed or blocked. It is a serious condition that increases the risk of stroke if left untreated.

What is the prognosis for a stroke in the carotid artery? ›

Patients presenting symptomatically with an occluded ipsilateral ICA have a poor prognosis in the long term. For those who present with transient or minor ischemic stroke symptoms, the annual risk of subsequent stroke has been determined to be 5% to 7% and the annual mortality rate 6%.

Can you fix occluded carotid artery? ›

Carotid endarterectomy.

This is the most common treatment for severe carotid artery disease. After cutting along the front of the neck, a surgeon opens the blocked carotid artery and removes the plaques. The surgeon uses stitches or a graft to repair the artery.

Can you live with an occluded carotid artery? ›

A network of blood vessels at the base of the brain, called the circle of Willis, can often supply the necessary blood flow. Many people function normally with one completely blocked carotid artery, provided they haven't had a disabling stroke.

Is occlusion the same as a stroke? ›

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events.

What is the prognosis for ischemic stroke? ›

Patients who have had a stroke are at high risk of subsequent strokes and each tends to worsen neurologic function. About 25% of patients who recover from a first stroke have another stroke within 5 years. After an ischemic stroke, about 20% of patients die in the hospital; mortality rate increases with age.

What are the two types of strokes which shows worse prognosis? ›

Overall, the general prognosis of ischemic stroke is considered better than that of hemorrhagic stroke, in which death occurs especially in the acute and subacute phases [2,3].

What is the most common cause of carotid occlusion? ›

Carotid artery occlusive disease is caused by atherosclerosis. Atherosclerotic plaques accumulate in the walls of the arteries and cause them to narrow (stenosis), or become so thick they completely block the flow of blood (occlude). This disease process increases your risk of having a stroke.

What are the symptoms of internal carotid artery occlusion? ›

Carotid Artery Blockage Symptoms
  • Blurred vision or vision loss.
  • Confusion.
  • Memory loss.
  • Numbness or weakness in part of your body or one side of your body.
  • Problems with thinking, reasoning, memory and speech.

How do you treat total ICA occlusion? ›

Common carotid artery total occlusion is rare but can be associated with a variety of neurological symptoms due to inadequate cerebral perfusion. The treatment includes bypass surgery, endarterectomy, and endovascular revascularization.

How long can you live with an occluded artery? ›

So, how long can you live with blocked arteries? Well, there is no set timeframe when it comes to a person's lifespan when their arteries become clogged. Medical treatments are available after the blockage is discovered to increase blood flow and prevent further complications.

Can you live with a 70% blocked carotid artery? ›

Narrowing of the carotid arteries between 50-70% carries a low risk of stroke and should be monitored. Narrowing of the carotid arteries more than 70% carries a 2-4% risk of stroke per year (10-20% over five years).

Can you live a normal life after carotid artery surgery? ›

Average carotid artery recovery time

After surgery, most people can return to normal activities within three to four weeks. Although, many get back to their daily routines as soon as they feel up to it.

Can you unblock a carotid artery without surgery? ›

Other new non-surgical options to treat blockages in the carotid arteries include balloon angioplasty and stents. Both of these procedures use a catheter-guided balloon, inflated in the blocked area, to open up the carotid artery. A metal stent may be inserted to help keep the artery expanded.

What percentage of carotid blockage requires surgery? ›

If a carotid artery is narrowed from 50% to 69%, you may need more aggressive treatment, especially if you have symptoms. Surgery is usually advised for carotid narrowing of more than 70%.

Can a 100% blocked carotid artery be unblocked? ›

Chronic total occlusions are arteries that are 100 percent blocked by plaque. These arteries are blocked for several months, if not years. Two procedures can treat this condition: bypass surgery or a non-invasive procedure done in the cath lab.

How serious is an 80% blockage in a carotid artery? ›

A carotid artery is usually considered nearly blocked when it's more than 80 percent blocked. At that point, you're at high risk for a transient ischemic attack (TIA) or a stroke. A TIA is also known as a ministroke because it causes stroke symptoms that last from a few minutes to a few hours.

Does walking help carotid arteries? ›

Walk training with blood flow reduction can improve thigh muscle size/strength as well as carotid arterial compliance, unlike high-intensity training, in the elderly.

Can you stent a blocked carotid artery? ›

Two procedures can be used to treat a carotid artery that is narrowed or blocked. These are: Surgery to remove plaque buildup (endarterectomy) Carotid angioplasty with stent placement.

What are the 2 types of occlusion? ›

There are two types, an anterior and a posterior crossbite. The anterior occurs when your lower teeth fit behind your upper teeth. A posterior crossbite happens when your upper teeth fit behind your lower teeth.

What is the most commonly occluded artery stroke? ›

The middle cerebral artery (MCA) is the most common artery involved in acute stroke. It branches directly from the internal carotid artery and consists of four main branches, M1, M2, M3, and M4.

Can you live a normal life after an ischemic stroke? ›

How Does a Stroke Impact Life Expectancy? Despite the likelihood of making a full recovery, life expectancy after stroke incidents can decrease. Unfortunately, researchers have observed a wide range of life expectancy changes in stroke patients, but the average reduction in lifespan is nine and a half years.

Can a person fully recover from an ischemic stroke? ›

Some people recover fully. Other people will have health problems or a disability. The fastest recovery takes place in the first few months. After that progress can be slower, but people can continue to improve for months or years after a stroke.

How long does it take to fully recover from an ischemic stroke? ›

Recovery time after a stroke is different for everyone—it can take weeks, months, or even years. Some people recover fully, but others have long-term or lifelong disabilities. Learn more about stroke rehabilitation from the National Institute of Neurological Disorders and Stroke.

What type of stroke has poor prognosis? ›

Stroke can be divided into 2 main types, which are ischemic and hemorrhagic stroke. Patients who suffer ischemic strokes have a tendency of better chance for survival than those who experience hemorrhagic strokes, as hemorrhagic stroke not only damages brain cells but also may lead to increased pressure on the brain.

What is the difference between stroke and ischemic stroke? ›

The main difference between the two types of stroke is the underlying cause of the brain damage. In ischemic stroke, the damage is caused by a lack of blood supply, while in hemorrhagic stroke, it is caused by bleeding into the brain tissue.

What is the most common cause of ischemic stroke? ›

Ischemic strokes are usually caused by a piece of plaque or a blood clot that blocks blood flow to the brain.

What causes internal carotid artery occlusion? ›

Internal Carotid Artery Occlusion
  • Agents Acting on the Eye.
  • Brain Hemorrhage.
  • Infarction.
  • Stenosis.
  • Brain Ischemia.
  • Aneurysm.
  • Transient Ischemic Attack.
  • Carotid Artery Obstruction.

Does your neck hurt when your carotid artery is blocked? ›

Your neck may feel tender in the area of the artery. The pain often goes up the neck to the jaw, ear, or forehead. Some diseases can cause carotidynia. Your doctor will check for those.

What is the treatment for internal carotid artery? ›

Endovascular repair is a less invasive option compared to open surgery. You may be eligible for endovascular stent grafting depending on the size of the aneurysm and its location in your carotid artery. Endovascular means that surgery is performed inside of your artery using long, thin tubes (catheters).

Is carotid artery blockage serious? ›

Carotid artery disease is serious because it can block the blood flow to your brain, causing a stroke. Too much plaque in the artery can cause a blockage. You can also have a blockage when a piece of plaque or a blood clot breaks off the wall of an artery.

What medication is used for carotid artery occlusion? ›

Medications. Medications that may be used to treat carotid artery disease include: Antiplatelet medications - medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel, ticlopidine, and dipyridamole are examples of antiplatelet medications.

Is an ICA occlusion a stroke? ›

Ischemic stroke caused by ICA occlusion can present with clinical features that are indistinguishable from those associated with other causes of stroke. In some patients, however, careful history taking may uncover a hemodynamic origin of cerebral or retinal ischemia, suggesting ICA occlusion.

Can you live with chronic total occlusion? ›

If the blockage stays in place for three months or longer, it's called CTO (chronic total occlusion). This is a life-threatening condition that deprives the heart of oxygen. Without proper treatment, CTO often leads to a poor quality of life and even more serious conditions such as heart failure.

Is an occlusion the same as a blood clot? ›

Most occlusions are caused by either a blood clot or the buildup of fatty plaque in the arteries (atherosclerosis). A blood clot can form at the site of occlusion, or it can travel from another area through the bloodstream and block an artery. That runaway clot is called an embolism.

Can you stent a completely occluded artery? ›

Coronary arteries with severe blockages, up to 99%, can often be treated with traditional stenting procedure. Once an artery becomes 100% blocked, it is considered a coronary chronic total occlusion, or CTO. Specialized equipment, techniques and physician training are required to open the artery with a stent.

At what percent blockage are stents given? ›

An artery should be clogged at least 70% before a stent should be placed in it.

Can you stent a 70 blocked artery? ›

"Patients typically develop symptoms when an artery becomes narrowed by a blockage of 70 percent or more," says Menees. "Most times, these can be treated relatively easily with stents.

Can blocked carotid artery cause dementia? ›

Traditionally thought to only contribute to vascular dementia, carotid artery disease has increasingly been associated with all-cause dementia and Alzheimer's disease.

What is the mortality rate of carotid artery stenosis? ›

Conclusion: Adult male patients with high-grade asymptomatic carotid artery stenosis demonstrate a mortality rate of 37% at a mean follow-up of 4 years.

How long can you live with a stent in your carotid artery? ›

This study demonstrated that carotid artery stenting in elderly patients has high efficacy and is safe in the periprocedural period and that patients survive long enough to benefit from the procedure. When selected appropriately, the majority of patients survive to 3 and 5 years after the procedure.

What is the long term prognosis for a carotid endarterectomy? ›

In this long-term follow-up, the median survival after carotid endarterectomy for patients with an asymptomatic stenosis was 10.2 years. Although the perioperative mortality was low (0.5%), the increasing annual mortality negatively affects longevity when compared with expected survival for this age group.

What is the quality of life after a carotid endarterectomy? ›

Conclusion. In summary, this study supports the conclusion that patients subjected to carotid endarterectomy perceive their quality of life as improved six months after surgery although they are more dependent in ADL activities.

What is the treatment for complete occlusion of the left internal carotid artery? ›

Common carotid artery total occlusion is rare but can be associated with a variety of neurological symptoms due to inadequate cerebral perfusion. The treatment includes bypass surgery, endarterectomy, and endovascular revascularization.

How do you treat ICA occlusion? ›

For occlusion of the ICA without a stump and supraclinoid filling, extracranial–intracranial artery bypass could be a therapeutic choice. In a previous study, Inoue et al. (2015) reported that surgical embolectomy might be considered as an additional therapeutic strategy to treat ICA terminus occlusion.

What percentage of ICA stenosis is severe? ›

Beyond quantification of stenosis, the NASCET ratio has been used to categorize carotid stenosis as moderate (≥50%–69%) and severe (≥70%).

How do you clear a blocked carotid artery without surgery? ›

Other new non-surgical options to treat blockages in the carotid arteries include balloon angioplasty and stents. Both of these procedures use a catheter-guided balloon, inflated in the blocked area, to open up the carotid artery. A metal stent may be inserted to help keep the artery expanded.

What percentage of carotid artery blockage requires surgery? ›

If a carotid artery is narrowed from 50% to 69%, you may need more aggressive treatment, especially if you have symptoms. Surgery is usually advised for carotid narrowing of more than 70%.

What is the most common occlusion in stroke? ›

Occlusion of the MCA or its branches is the most common type of anterior circulation infarct, accounting for approximately 90% of infarcts and two thirds of all first strokes.

Can you put a stent in the carotid artery? ›

In carotid stenting, a surgeon sends a long, hollow tube, known as a catheter, through the arteries to the narrowed carotid artery in the neck. The surgeon then puts a small wire mesh coil, known as a stent, into the vessel to keep the artery from narrowing again.

Is carotid artery blockage reversible? ›

For the practicing clinician, this study demonstrates that carotid atherosclerosis is reversible by long-term adherence to dietary strategies to induce weight loss.

How quickly does carotid stenosis progress? ›

Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis. Previous largescale studies have found that ∼20% of patients with asymptomatic carotid stenosis will experience disease progression within 10 years.

What are the stages of carotid stenosis? ›

Carotid artery stenosis is generally divided into three groupings: mild, moderate and severe. A mild blockage is one that's less than 50%. This means that less than half of your artery is blocked. A moderate blockage is between 50% and 79%.


1. Understanding Carotid Artery Stenosis
(Zero To Finals)
2. Management of Acute Ischemic Stroke From Emergent Large Vessel Occlusions: Past, Present and Future
(Icahn School of Medicine)
3. ACNS Webinar - Treatment of Acute and Chronic Carotid Occlusion
4. TCAR | TransCarotid Artery Revascularization Procedure Narrated Animation | Silk Road Medical | 4min
(Silk Road Medical)
5. Carotid Doppler USS Role in Acute Ischemic Stroke by Assoc Prof Mohd Hashairie Fauzi, Consultant EP
(merpati biru)
6. Ischemic Stroke(patho, causes, Clinical features, lab, Tx)
(USMLE exam gym)


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