Endovascular treatment of acute ischemic stroke due to isolated internal carotid artery occlusion: treatment strategy, outcomes and prognostic factors (2023)

partial fragment

Materials and methods

This study was conducted in accordance with the 1964 Declaration of Helsinki and was approved by the Institutional Ethics Committee. Due to the retrospective design of the study, the requirement for informed consent was waived. Data for this study are available upon reasonable request.


Table 1 shows baseline characteristics and clinical outcomes. The mean age of the 66 patients with isolated ICA occlusion was 69.3 years (SD, 13.3), of whom 42 (63.6%) were women. Median NIHSS score at admission was 15 (IQR, 10-21), median initial ASPECT score was 7 (IQR, 7-9), and median time from onset to perforation was 327 minutes (IQR, 198-408) Only An intact circle of Willis was observed in 19 patients (28.8%), and intracranial ICA occlusion was present in 39 patients (59.1%). In 44 (66.7%) patients


This study evaluated the use and efficacy of EVT in the treatment of acute moderate to severe stroke in patients with pure ICA occlusion and demonstrated that EVT is safe and effective in these patients. Furthermore, the current findings suggest that mTICI 3 reperfusion is the only treatment-independent factor associated with clinical outcome in patients with isolated ICA occlusion after EVT across a range of baseline characteristics.

Although a branch of intracranial blood flow

conflict of interest

The authors declare that they have no known financial interests or personal relationships that could influence the work reported in this article.

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How is endovascular stroke treated? ›

The treatment involves placing a catheter into the brain and removing the clot that's causing the stroke. Endovascular therapy must be done within six to eight hours of the onset of a stroke, depending on the location. Endovascular treatment can restore blood flow within minutes.

How do you treat a complete occlusion of the ICA? ›

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.

What is the endovascular therapy? ›

What is Endovascular Therapy? Endovascular treatments are minimally invasive procedures that are done inside the blood vessels and can be used to treat peripheral arterial disease, or PAD, which is a common type of vascular problem in the leg, aorta or carotid.

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 success rate of endovascular repair? ›

EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years.

What is the two year outcome after endovascular treatment for acute ischemic stroke? ›

The cumulative 2-year rate of death was 26.0% in the intervention group and 31.0% in the control group (adjusted hazard ratio for death, 0.9; 95% CI, 0.6 to 1.2; P=0.46) (Figure 2).

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 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.

Can you reverse occlusion? ›

While there's no way to completely reverse the condition, medication and lifestyle changes can significantly slow down the progression of the disease and reduce your risk of complications.

What is the disadvantage of endovascular repair? ›

A disadvantage is that some patients have to undergo a further operation at a later stage to refine the initial procedure. Not every patient or every aneurysm is suitable for EVAR. In particular, aneurysms arising close to or above the kidneys are more difficult to treat in this way.

What is the goal time for endovascular therapy? ›

Patients treated within 60 minutes experienced improved outcomes, including lower in-hospital mortality and reduced long-term disability.

How long is recovery from endovascular treatment? ›

In the past, this condition was treated by open surgery, involving an incision in the side of the chest or breastbone and a long recovery period. Patients generally stay in the hospital for seven to 10 days following open surgery and undergo a three-month recovery.

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.

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.

What is the mortality rate of carotid artery occlusion? ›

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%.

What is considered a main benefit of endovascular? ›

Medical uses. Endovascular coiling is used to treat cerebral aneurysms. The main goal is prevention of rupture in unruptured aneurysms, and prevention of rebleeding in ruptured aneurysms by limiting blood circulation to the aneurysm space.

What is the long term outcome of EVAR? ›

Endovascular aneurysm repair (EVAR) has demonstrated superior results in terms of morbidity and mortality compared with open surgical treatment in the short term. 1, 2, 3 However, late outcomes have exhibited higher reintervention rates and aneurysm-related mortality for patients who have undergone EVAR.

Who is a candidate for endovascular surgery? ›

Who is a candidate for endovascular aneurysm repair? You may benefit from EVAR if you have an aortic aneurysm. Aortic aneurysms affect the body's largest artery, the aorta. Not all aneurysms need treatment.

What are the 2 major acute treatments approved for ischemic stroke? ›

Consent: Intravenous thrombolysis and EVT are considered the standard of care for acute stroke treatment.

What is the average recovery time for an ischemic stroke? ›

The most rapid recovery usually occurs during the first three to four months after a stroke, but some survivors continue to recover well into the first and second year after their stroke.

What is the maximum time from last known well when endovascular therapy can be performed? ›

Conclusions. For acute stroke patients, the late and the unknown time window of up to 24 hours after last seen normal is now open for treatment with intravenous as well as with endovascular reperfusion therapies.

Can a 100% blocked carotid artery be fixed? ›

If you have had a stroke or TIA, or if you have a severely blocked carotid artery, you may benefit from surgery to remove the plaque. This surgery is called a carotid endarterectomy. This procedure is time-sensitive and should be done soon after the stroke or TIA, with the goal of preventing another stroke.

What are the odds of surviving carotid artery surgery? ›

death – there's a less than 1% risk of death, which can occur as a result of complications such as a stroke or heart attack.

How long does it take to unblock a carotid artery? ›

A carotid endarterectomy usually takes 1 to 2 hours to perform. If both of your carotid arteries need to be unblocked, 2 separate procedures will be carried out. One side will be done first and the second side will be done a few weeks later.

What happens when a carotid artery is occluded? ›

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 is the endovascular treatment for carotid artery stenosis? ›

Carotid endarterectomy (CEA) - the standard treatment for carotid stenosis - substantially reduces the risk of recurrent stroke among patients who have had ischaemic symptoms such as stroke or transient ischaemic attack attributable to the stenosis.

What is the treatment for a 70 blocked carotid artery? ›

Treatment for severe carotid stenosis involves eliminating the artery blockage. The most common way to do that is with a surgery called “carotid endarterectomy.” It's performed by making an incision along the front of the neck, opening the carotid artery and removing the plaque.

Can you stent a 100% occlusion? ›

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.

What vitamin removes plaque from arteries? ›

Optimal Vitamin K2 intake is crucial to avoid the calcium plaque buildup of atherosclerosis, thus keeping the risk and rate of calcification as low as possible.

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.

How long is recovery from endovascular surgery? ›

You may feel more tired than usual for 1 to 2 weeks after surgery. You may be able to do many of your usual activities after 1 to 2 weeks. But you will probably need up to 4 weeks to fully recover.

What is the difference between endovascular and vascular surgery? ›

Vascular surgery and endovascular surgery are both modalities to treat vascular disease. Endovascular describes a minimally invasive approach commonly done through needle puncture and a sheath. Traditional vascular surgery is more invasive and involves incisions, which is more surgical in nature.

What does endovascular repair do? ›

The goal of endovascular aneurysm repair is to prevent the abdominal aortic aneurysm from bursting, which is a life-threatening event. The force of blood flow against a weak spot in the wall of the blood vessel (here the aorta) causes the aortic walls to balloon outward, creating an aneurysm.

What to expect after endovascular embolization? ›

After Embolization

You will need to lie still for 6-8 hours. You can expect a two-day hospital stay, and an extended stay if you have any complications. When you get home, you may have to adjust your activity level while you recover. This may take up to a week.

What are the risks of endovascular embolization? ›

Risks from the procedure may include:
  • Bleeding at the site of the needle puncture.
  • Bleeding in the brain.
  • Damage to the artery where the needle is inserted.
  • Dislodged coil or balloon.
  • Failure to completely treat the abnormal blood vessel.
  • Infection.
  • Stroke.
  • Symptoms that keep returning.
Jan 28, 2021


1. Acute Dissections and Ischemic Stroke
(Neurovascular Exchange)
2. Imaging Acute Ischemic Stroke - Complete Lecture | Health4TheWorld Academy
(Health4TheWorld Academy Videos Channel)
3. GNI Grand Rounds: Carotid Artery Stenosis Review and Current State of Treatment Options
(Global Neurosciences Institute)
4. Cervical Arterial Dissections
(The Neurophile (by Rutgers RWJMS Neurology))
5. SIR-RFS Webinar (2/27/2018): Neuro Interventional Radiology: Carotid Artery Stenting
(IR Education)
6. Management of Acute Stroke
(MedStar Georgetown Department of Medicine)


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