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Abstract Details

Early Spontaneous Recanalization of Symptomatic Carotid Occlusion: When Should We Be Looking?
Cerebrovascular Disease and Interventional Neurology
P01 - (-)
238
BACKGROUND: Carotid occlusion is a known cause of acute ischemic stroke. In a small number of patients, recanalization can occur. When and in whom reimaging should occur has not been clearly delineated.
DESIGN/METHODS: Case report and literature review.
RESULTS: A 65 year old, right-handed male with a history of smoking, diabetes, hypertension, and hyperlipidemia presented to an outside hospital with acute onset of right-sided weakness and aphasia. He improved rapidly, and was admitted for a suspected transient ischemic attack. He was transferred to our institution two days later when his clinical exam deteriorated. His initial NIH Stroke Scale (NIHSS) score was 8. A CT angiogram done prior to transfer showed a left carotid occlusion, which was confirmed at our institution by carotid ultrasound and repeat CT angiogram (Figure 1). An MRI showed patchy infarcts in the left MCA territory. Nine days after transfer, his aphasia worsened and his right arm weakness increased. His NIHSS score at that time was 10. Repeat MRI/MRA imaging of the brain showed new areas of restricted diffusion. A CT angiogram showed 90% stenosis of the internal carotid artery at the bulb. On conventional angiography, 75% stenosis was seen; a carotid stent was placed. He improved and was discharged to a rehabilitation facility with an NIHSS score of 8. Including this case, 58 cases (mean age 65.6 y) of spontaneous recanalization have been published (Table 1). Average length of time between occlusion and recanalization was 24.5 months (range: 3 days-96 months); 12 cases (20.7%) were symptomatic at recanalization. Surgical treatment or stenting followed recanalization in 14 of 58 (24.1%).
CONCLUSIONS: Spontaneous recanalization of an occluded carotid artery may occur in a subacute fashion. Clinical deterioration, even minor, should prompt an investigation into possible recanalization.
Authors/Disclosures
Shawna M. Cutting, MD, FAAN
PRESENTER 		The institution of Dr. Cutting has received research support from Genentech.
Thomas Dehmel (Neurology) No disclosure on file
James Conners, MD (Rush University Medical Center) The institution of Dr. Conners has received research support from nih.
Shyam Prabhakaran, MD (University of Chicago) Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Sarah Song, MD, MPH, FAAN (Rush University Medical Center) Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.