Recanalization Rate and Clinical Outcome in Acute Carotid-T Occlusion

Abstract

Background: Acute carotid-T occlusion results in both low recanalization rates and poor outcomes. We investigated clinical outcomes and recanalization in a rare case of thrombolytic therapy. Methods: A consecutive series of patients with acute carotid-T occlusion who were treated with either bridging intravenous (IV) plus intra-arterial (IA) thrombolysis or IA alone were analyzed. Complete recanalization was defined as a thrombolysis in cerebral infarction (TICI) grade of 3. A favorable outcome was defined as a modified Rankin Scale (mRS) score of ≤2. Results: Of the 40 patients, 6 (15%) had favorable outcomes, and 34 (85%) had poor outcomes. Favorable outcomes were significantly associated with a lower National Institutes of Health Stroke Scale (NIHSS) score after revascularization treatment and higher rates of complete recanalization (p < 0.01, p < 0.024, respectively). Complete recanalization was achieved in all patients with favorable clinical outcomes and 5 (83%) patients had received combined IV/IA thrombolysis (p = 0.381). Conclusions: The results suggest that complete recanalization for acute carotid-T occlusion improves clinical outcomes. In that regard, bridging IV/IA thrombolysis may be more efficacious than IA alone.