ANGIOPLASTY OF THE OCCLUDED INTERNAL CAROTID-ARTERY

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.