Abstract 121: Management And Outcomes Of Acute Extracranial Occlusions Of Internal Carotid Arteries With Patent Intracranial Vasculature

• Published in: Stroke: vascular and interventional neurology Vol. 4; no. S1
• Main Authors: Lingam, S., Liu, W., Galate, V., Slavin, S.
• Format: Journal Article
• Language: English
• Published: Phoenix Wiley Subscription Services, Inc 01.11.2024
• Subjects: Clinical deterioration; Mortality
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.04.suppl_1.121

IntroductionAcute occlusion of internal carotid artery (ICA) is the underlying etiology in up to 15% of all ischemic strokes and is often associated with greater severity, functional disability, and mortality. There are no clear guidelines on the acute endovascular management of isolated extracranial ICA occlusion (eICAO) without intracranial occlusion.MethodsWe conducted a retrospective chart review at our comprehensive stroke center including subjects ≥18 from 2019‐2023 who presented with isolated acute extracranial ICA occlusion with patent intracranial flow.Results40 patients met inclusion criteria (mean age 62.3 ± 12.3, 70% male), with 23 (57.5%) receiving endovascular thrombectomy (EVT). Among those, 19 patients underwent EVT immediately on arrival and 4 patients were initially admitted for medical management and observation but eventually underwent EVT after clinical deterioration. There was a statistically significant difference in the admission National Institute of Health Stroke Scale (NIHSS), discharge modified Rankin Scale (mRS) and 90‐day mRS between the 3 groups (Table 1). There were also notable nonsignificant trends towards greater symptomatic hemorrhage and mortality in the immediate EVT group. To evaluate admission NIHSS as a confounder for poorer outcomes, a multiple linear regression with discharge mRS as the response variable was conducted using 3 predictors: 2 main effects (admission NIHSS, EVT usage) plus 1 interaction term between the two (admission NIHSS*EVT usage) (Figure 1). This showed that in patients with admission NIHSS <14, immediate EVT was associated with significantly worse mean predicted discharge mRS when compared to not using EVT.CONCLUSIONSIn patients with isolated extracranial ICA occlusion and low NIHSS, immediate EVT appears to be associated with poor outcome. Our study suggests that delaying EVT until clinical worsening may be beneficial in these patients. More research with greater numbers is indicated to evaluate patient‐specific factors to select those who would benefit from immediate EVT.