PURPOSE: To review patients who have presented with acute strokes from
a middle cerebral artery occlusion in whom in addition to the middle
cerebral artery thromboembolus, an internal carotid artery occlusion h
as been present, and in whom angioplasty of these totally occluded int
ernal carotid arteries has been successful. METHODS: We reviewed retro
spectively our experience in treating acute stroke patients with intra
cranial, intraarterial urokinase. Six of 27 patients had internal caro
tid artery occlusions in addition to middle cerebral artery occlusions
. Two patients presented with spontaneous carotid dissections for whic
h no further intervention from the ipsilateral internal carotid artery
was attempted. in the remaining four internal carotid artery occlusio
ns secondary to atherosclerotic disease, standard guide wires and cath
eters were negotiated across the level of the internal carotid artery
occlusion, which expedited intracranial catheterization for thrombolys
is. Subsequently, angioplasty of the internal carotid artery was perfo
rmed. RESULTS: All four occluded internal carotid arteries could be tr
aversed. No new neurologic deficits occurred. No vascular injuries occ
urred. No deaths occurred. Four- to 6-month follow-up showed all four
internal carotid arteries remained patent, CONCLUSION: In acute occlus
ions of the internal carotid artery from atherosclerosis, the occluded
vessel can sometimes be recanalized with low morbidity. In addition,
endovascular access to the intracranial circulation can be expedited b
y using the recanalized internal carotid artery.