Prognostic Factors for Neurologic Outcome after Endovascular Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery

Abstract

BACKGROUND AND PURPOSE: Management of acute symptomatic internal carotid artery (ICA) occlusion remains controversial. We evaluated outcome predictors of a good recovery in patients with acute symptomatic ICA occlusion.

MATERIALS AND METHODS: We retrospectively evaluated 33 consecutive patients (men/women, 23/10; mean age, 66 years) with: 1) acute symptomatic ICA occlusion within 6 hours of symptom onset or with mismatch of symptoms and an early infarct area, 2) National Institutes of Health Stroke Scale (NIHSS) score of 6 or more, and 3) attempted endovascular revascularization of the occluded ICA. Various single and multiple variable analyses were conducted to assess the association of 14 predictors with short-term (1-month NIHSS) and long-term (1-year modified Rankin Scale [mRS]) outcomes.

RESULTS: Successful recanalization (at or more than grade 2 distal residual occlusion) was obtained in 14 (42%) of 33 and good recovery (mRS ≤2) after 1 year in 11 (33%) of 33. Distal residual occlusion (DRO; P = .005), initial NIHSS score (P = .023), and postprocedural thrombolysis in cerebral infarction (P = .027), retrograde ICA filling (P = .036), and ophthalmic collaterals (P = .046) were significant predictors of short-term outcome. DRO (P = .018) and initial NIHSS (P = .033) were significant predictors of long-term outcome on univariable analysis. DRO was the only significant predictor for short-term (P = .026) and long-term outcome (P = .033) on multivariable logistic regression.

CONCLUSIONS: Active revascularization of acute symptomatic ICA occlusion resulted in good recovery in one third of patients after 1 year. DRO is an independent predictor of a favorable clinical outcome.