Abstract Details

Title Is Intracranial Intra-Arterial Thrombolysis and Thrombectomy Expertise Necessary for Carotid Artery Stent Procedures in Contemporary Practice?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 046

Objective

Background BACKGROUND: CAS is performed by multiple specialties with some specialties having expertise to perform intracranial intra-arterial thrombolysis and thrombectomy in the event of cerebral ischemic event during procedure.However, such added advantage would depend upon the rate of cerebral ischemic events amenable to such intervention.

Design/Methods DESIGN/METHODS: We reviewed prospectively collected data supplemented by chart review for all patients undergoing CAS performed by specialties with intracranial catheterization expertise to identify patients who may have required emergent intra-arterial thrombolysis and thrombectomy for cerebral ischemic events and associated outcomes.

Results RESULTS: A total of 26 (11.3%) out of 231 patients had neurological deterioration, including transient symptomatic hypotension (n=8, 3.3%), ischemic strokes (n=10, 4.3%), transient ischemic attack (n= 3, 1.3%), hyperperfusion syndrome (n= 1, 0.4%), intracerebral hemorrhage (n=3, 1.3%), and restenosis (n=2, 0.8%). One patient had both a restenosis and stroke.Patients with neurological deterioration following CAS had higher Cerebral angiography at the time of symptom onset was performed in 6 patients and demonstrated a focal occlusion in 3 patients, delayed intracranial contrast clearance in 1 patient, and stent occlusion in 2 patients. Intra-arterial thrombolysis and thrombectomy was used in 1 patient following CAS. The patient developed right sided weakness and aphasia associated with occlusion of the left middle cerebral artery two hours post-procedure. Four patients received IV infusion of Eptifibatide. Two patients had intraoperative symptoms of stroke, one had delayed intracranial contrast clearance, and another had distal branch occlusion on angiography. One patient was treated for suspicion of microemboli related ischemic event and another patient for intra-procedural stent occlusion.

Conclusions CONCLUSIONS: Although neurological deterioration following CAS can be infrequently seen, the rate and value of intra-arterial thrombolysis and thrombectomy for cerebral ischemic events is very low.

Authors/Disclosures
PRESENTER	No disclosure on file
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Hesham A. Allam, MD (Saint Louis University Hospital)	Dr. Allam has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Laura J. Balcer, MD, MSCE, FAAN (NYU Grossman School of Medicine)	An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children's Hospital of Philadelphia.

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