Article Figures & Data
Figures
- Fig 1.
A 64-year-old man with cardiac arrhythmia presented with dysarthria, facial palsy, and left-sided weakness. The patient had improvement of the NIHSS score from 14 to 2. His mRS was 1 after 1 year.
A, Anteroposterior view of the right common carotid arteriogram shows complete occlusion of the right ICA.
B, The left ICA arteriogram reveals good leptomeningeal collateral circulation through the anterior cerebral artery. Note the filling defects (arrows) in the right M1 because of intracranial emboli.
C, Reopening of the right ICA bulb with stent placement reveals a residual filling defect (arrow) in the right M2 segment.
D, Final angiogram obtained after intra-arterial administration of thrombolytic agents showed no residual emboli in the middle cerebral arterial branches.
- Fig 2.
A 60-year-old man presented with left-sided motor weakness. The patient had improvement of NIHSS score from 9 to 7. His mRS was 4 after 1 year.
A, The right ICA arteriogram shows complete occlusion of the right ICA. Good collateral circulation through the ophthalmic artery reveals no intracranial occlusion.
B, The left ICA arteriogram shows filling of the right anterior cerebral artery through the anterior communicating artery.
C, Vertebral angiogram shows a good leptomeningeal collateral circulation.
D, Microcatheter introduction reveals an occluded end of ICA below the level of the ophthalmic artery. The ICA occlusion could not be revascularized. There was a trigeminal artery variation.
Tables
DRO Grade 0 1 2 3 Total No. of patients 13 6 4 10 33 No. of recanalized ICA (rate) 19 (58%) 14 (42%) 33 Initial NIHSS, median (range) 15 (6–22) 17 (12–27) 11.5 (8–18) 10.5 (6–21) 1-month NIHSS, median (range) 14 (2–42*) 29 (6–42) 7 (1–14) 5 (2–17) No. of deaths 3 3 0 0 6 (18%) mRS >3 at 1 year (mean mRS %) 10 (77) 6 (100) 2 (50) 4 (40) 22 (67) mRS ≤2 at 1 year (mean mRS %) 3 (23) 0 (0) 2 (50) 6 (60) 11 (33) Note:—DRO indicates distal residual occlusion; ICA, internal carotid artery; NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale. DRO grades are defined in the text.
* NIHSS score of 42 means death.
Variables (Based on NIHSS) Odds Ratio (95% CI) P Age (≥ 65 vs <65) 2.75 (0.63–11.97) .178 Sex (male vs female) 1.38 (0.31–6.20) .679 Occlusion level (above vs below the OA) 4.00 (0.65–24.69) .136 Retrograde ICA filling (no vs yes) 6.50 (1.13–37.48) .036 Tandem intracranial occlusion (yes vs no) 3.06 (0.68–13.79) .145 Type of occlusion (embolic vs de novo) 1.88 (0.47–7.53) .375 TICI collaterals (grade 0, 1 vs grade 2, 3) 0.69 (0.16–2.87) .606 Ophthalmic collaterals (no vs yes) 5.00 (1.04–24.03) .046 Initial NIHSS score (>12 vs ≤ 12) 6.29 (1.29–30.54) .023 Distal residual occlusion (grade 0, 1 vs grade 2, 3) 13.00 (2.19–77.27) .005 Postprocedural TIMI (grade 0, 1 vs grade 2, 3) 3.00 (0.72–12.46) .131 Postprocedural TICI (grade 0, 1 vs grade 2, 3) 5.50 (1.22–24.81) .027 Time from onset to procedure (≥ 4 vs <4 h) 0.24 (0.05–1.12) .069 Infarction volume (≥ 30 mL vs <30 mL) 2.36 (0.58–9.58) .231 Note:—NIHSS indicates National Institutes of Health Stroke Scale; CI, confidence interval; OA, ophthalmic artery; ICA, internal carotid artery; TICI, Thrombolysis in Cerebral Infarction; TIMI, Thrombolysis in Myocardial Infarction.
Variables (based on mRS) Odds Ratio (95% CI) P Age (≥65 vs <65) 1.46 (0.34–6.35) .615 Sex (male vs female) 1.52 (0.33–7.15) .593 Occlusion level (above vs below OA) 3.75 (0.39–35.92) .252 Retrograde ICA filling (no vs yes) 4.08 (0.87–19.23) .075 Tandem intracranial stenosis (yes vs no) 3.12 (0.54–17.97) .204 Type of occlusion (embolic vs de novo) 2.53 (0.57–11.26) .224 TICI collaterals (grade 0, 1 vs grade 2, 3) 1.20 (0.27–5.25) .809 Ophthalmic collaterals (yes vs no) 4.67 (1.00–21.895) .051 Initial NIHSS score (>12 vs ≤ 12) 5.71 (1.15–28.35) .033 Distal residual occlusion (grade 0, 1 vs grade 2, 3) 7.11 (1.40–36.12) .018 Postprocedural TIMI (grade 0, 1 vs grade 2, 3) 2.67 (0.56–12.79) .220 Postprocedural TICI (grade 0, 1 vs grade 2, 3) 4.67 (0.96–22.79) .057 Time from onset to procedure (≥ 4 vs <4 h) 0.60 (0.12–2.89) .525 Infarction volume (≥ 30 mL vs <30 mL) 2.10 (0.47–9.30) .328 Note:—mRS indicates modified Rankin Scale; CI, confidence interval; OA, ophthalmic artery; ICA, internal carotid artery; NIHSS, National Institutes of Health Stroke Scale; TIMI, Thrombolysis in Myocardial Infarction; TICI, Thrombolysis in Cerebral Infarction.
Variables (based on NIHSS) Odds Ratio (95% CI) P Age (≥ 65 vs <65) 2.21 (0.21–24.38) .517 Sex (male vs female) 2.52 (0.30–21.31) .396 Time from onset to procedure (≥ 4 vs <4 h) 0.07 (0.00–1.79) .108 Retrograde ICA filling (no vs yes) 0.34 (0.02–6.15) .468 Distal residual occlusion (grade 0, 1 vs grade 2, 3) 48.45 (1.60–1468.34) .026 Initial NIHSS score (>12 vs ≤ 12) 11.13 (0.69–179.42) .089 Note:—NIHSS indicates National Institutes of Health Stroke Scale; CI, confidence interval; ICA, internal carotid artery.
Variables (based on mRS) Odds Ratio (95% CI) P Age (≥ 65 vs <65) 0.84 (0.09–7.46) .874 Sex (male vs female) 4.91 (0.52–46.58) .166 Time from onset to procedure (≥ 4 vs <4 h) 0.66 (0.08–5.20) .693 Retrograde ICA filling (no vs yes) 0.50 (0.04–5.65) .573 Distal residual occlusion (grade 0, 1 vs grade 2, 3) 11.54 (1.22–109.30) .033 Initial NIHSS score (>12 vs ≤ 12) 4.85 (0.38–61.29) .222 Note:—mRS indicates modified Rankin Scale; CI, confidence interval; ICA, internal carotid artery; NIHSS, National Institutes of Health Stroke Scale.
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