Re-opening of carotid arteries in stroke has high success rate with stenting

University of Pittsburgh researchers report a high level of effectiveness in re-opening completely blocked internal carotid arteries (ICA) as late as two to three days after acute stroke symptoms by using stents.

The study at the University of Pittsburgh School of Medicine's Department of Neurology and University of Pittsburgh Medical Center's (UPMC) Stroke Institute, is in the November issue of Stroke, a peer-reviewed publication of the American Heart Association.

"This report breaks new ground in that it contradicts the conventional wisdom that a completely blocked or occluded carotid cannot be opened," said the study's lead author, Tudor Jovin, M.D., assistant professor of neurology and neurosurgery at Pitt's School of Medicine, and co-director of the Center for Endovascular Therapy at UPMC.

Dr. Jovin's team, which consisted of members of the UPMC Stroke Institute, retrospectively studied 25 patients with acute carotid occlusion who underwent angiography with the intent to revascularize the occlusion from January 2002 to March 2005.

Researchers concluded that recanalization, or re-opening of the artery, was successful in 23 of the 25 patients, and that the procedure was done safely.

"The main finding of the report was that endovascular revascularization of occluded ICA in the setting of acute or subacute ischemic stroke carries a high-revascularization rate and is safe in selected patients," Dr. Jovin reported.

"Management of stroke because of acute internal carotid artery occlusion continues to represent a challenge because it may result in significant disability in 40 percent and death in 20 percent of cases," Dr. Jovin said. "Our results are significant because they offer an opportunity for patients who may need more aggressive treatment. Future prospective studies are necessary to determine which patients are most likely to benefit from this form of therapy."

Dr. Jovin added that early restoration of flow in the occluded ICA may improve the symptoms of acute stroke, prevent worsening and reduce long-term stroke recurrence risk.

The study also demonstrated that ideal candidates for endovascular ICA revascularization would be patients with a small area of tissue irreversibly compromised and a large area of tissue that is viable but threatened to undergo infarction.

Michael B. Horowitz, M.D., associate professor of neurosurgery and radiology and director of the UPMC Center for Neuroendovascular Therapy, also participated in the study along with Rishi Gupta, M.D., fellow, department of neurology; Ken Uchino, M.D., assistant professor of neurology; Lawrence R. Wechsler, M.D., professor of neurology and director, UPMC Stroke Institute; Maxim D. Hammer, M.D., assistant professor of neurology, all from the University of Pittsburgh School of Medicine; and Charles A. Jungreis, M.D., professor of radiology and chair of radiology Temple University Hospital.

According to the American Heart Association, stroke is the third leading cause of death in the United States and is a primary cause of serious, long-term disability in adults. On average, someone in the U.S. suffers a stroke every 53 seconds, with 700,000 Americans experiencing a new or recurring stroke each year and approximately 160,000 Americans dying every year from stroke.