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Outcomes and prognostic factors after emergent carotid artery stenting for hyperacute stroke within 6 hours of symptom onset

 Yoon, Woong  ;  Kim, Byung Moon  ;  Kim, Dong Joon  ;  Kim, Dong Ik  ;  Kim, Seul Kee 
 NEUROSURGERY, Vol.76(3) : 321-329, 2015 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Carotid Artery, Internal/surgery* ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents/adverse effects ; Stroke/surgery* ; Time-to-Treatment* ; Treatment Outcome
Acute stroke ; Carotid artery disease ; Carotid artery stenting
BACKGROUND: The optimal treatment for hyperacute stroke attributable to cervical internal carotid artery (C-ICA) occlusion remains controversial. OBJECTIVE: This study sought to evaluate clinical outcomes and prognostic factors after carotid artery stenting (CAS) in patients with hyperacute stroke within 6 hours of onset. METHODS: Forty-seven patients with hyperacute stroke attributable to atherosclerotic C-ICA occlusion underwent emergent CAS. Forty-two patients (89.4%) had tandem intracranial artery occlusion (TIO). When patients showed remnant M1 or proximal M2 occlusions after CAS, intracranial recanalization therapy was performed by using pharmacologic thrombolysis and mechanical thrombectomy with a Solitaire stent. Clinical and radiologic data were compared between patients with favorable (modified Rankin scale, 0-2) and unfavorable outcomes. Binary logistic regression analysis was used to find independent prognostic factors. RESULTS: Emergent CAS was successful in all but 1 patient. Seven (16.7%) of 42 patients with TIO did not need further treatment, because thrombolysis in cerebral ischemia ≥2b was achieved immediately after CAS. Of the 35 patients who underwent intracranial recanalization therapy for remnant TIO, thrombolysis in cerebral ischemia ≥2b was achieved in 71.4% (25 of 35). Twenty-six patients (55.3%) had favorable outcomes, and mortality was 6.4% at 3 months. Time from symptom onset to carotid recanalization was inversely and independently associated with a favorable outcome for all patients and for those with TIO (P < .05). CONCLUSION: In our patient group, emergent CAS for hyperacute stroke caused by atherosclerotic C-ICA occlusion seemed to be effective and safe. Time to carotid recanalization was inversely and independently associated with a favorable outcome.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
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