Simultaneous open recanalization of the extracranial internal carotid artery in combination with endovascular thromboaspiration from its intracranial portions in acute period of ischemic stroke

• Shatravka A.V.
• Patlay I.I.
• Sokurenko G.Yu.
• Bolkhovskoy D.V.
• Kazarin L.A.
• Stepushenkova D.L.
• Gusinskiy A.V.
• Dzhumaeva A.A.

Abstract

Proposed herein is a method of hybrid open and endovascular recanalization of the extra- and intracranial portions of the internal carotid artery in patients in the acutest period of ischemic stroke. The method is aimed at restoring adequate blood flow in arteries of the anterior cerebral circulation.

Objective. The purpose of this study was to substantiate efficacy and feasibility of performing open recanalization of the proximal portion of the internal carotid artery with thromboaspiration from the intracranial segments in patients in the hyperacute period of ischemic stroke.

Patients and methods. We studied the results of hybrid recanalization of the internal carotid artery in 11 patients with acute ischemic stroke (Group 1). The control group included 14 patients subjected to endovascular recanalization of the internal carotid artery alone (Group 2). All patients were operated on at the Regional Clinical Hospital of the Kaliningrad Region.

Results. A longer time of hybrid operations, averagely amounting to 90 (60; 130) minutes versus 57 (40; 70) minutes (p<0.01) for endovascular recanalization of the internal carotid artery did not negatively affect further outcomes. Significant regression of neurological symptoms to the mRs score ≤2 was recorded at discharge in eight (72.7%) patients after hybrid operations, thus statistically differing from that in Group 2, i. e., three (21.4%) patients. Restoration of adequate blood flow on the mTICI 2c-3 scale was more frequent in Group 1 patients: nine (81.8%) versus five (35.7%) patients in Group 2, but the difference was statistically non-significant (p=0.06). The frequency of hemorrhagic transformations and lethal outcomes did not differ statistically in both groups.

Conclusion. A simultaneous hybrid method of open and endovascular recanalization of the extra- and intracranial portions of carotid arteries may be regarded as one of promising methods of surgical treatment of patients in the hyperacute period of ischemic stroke in acute thrombosis of the internal carotid artery.

Keywords:ischemic stroke; acute thrombosis; carotid thrombectomy; endovascular recanalization

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