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Vol. 3, No. 3, 2011
Issue release date: September – December
Section title: Published: December 2011

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Case Rep Neurol 2011;3:301–308
(DOI:10.1159/000335069)

Carotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke

Curtze S.a · Putaala J.a · Saarela M.a · Vikatmaa P.b · Kantonen I.b · Tatlisumak T.a
Departments of aNeurology, and bVascular Surgery, Helsinki University Central Hospital, Helsinki, Finland

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Abstract

Emergency endarterectomy of an occluded internal carotid artery (ICA) has not been investigated as an option of rescue therapy for severe acute ischemic stroke in the era of intravenous (IV) thrombolysis treatment neither as a primary treatment nor after failed IV thrombolysis. Data from the pre-IV thrombolysis era are conflicting and therefore emergency endarterectomy has not been recommended. The number of patients reaching the emergency room within the IV thrombolysis time window has vastly grown due to advanced acute stroke treatment protocols. The efficacy of mechanical thrombectomy as a primary or add-on to IV thrombolysis therapy option is being actively investigated. We herein report 2 cases of acute ischemic stroke with computerized tomography (CT) angiography-documented occlusion of an ICA that were treated with emergency carotid endarterectomy and embolectomy to restore cerebral blood flow. Both cases presented with severe stroke symptoms and signs not responding to IV thrombolysis and showed severe CT-perfusion deficits mainly representing ischemic penumbra. Blood flow was surgically restored after 5 h of symptom onset. Both patients achieved a favorable outcome. We conclude that timely surgical approach of acute ICA occlusion after failed thrombolysis as a rescue therapy may be a viable option in well-selected patients.

© 2011 S. Karger AG, Basel


  

Author Contacts

Sami Curtze
Department of Neurology, Helsinki University Central Hospital
Haartmaninkatu 4
FI–00290 Helsinki (Finland)
Tel. +358 50 5302 708, E-Mail sami.curtze@hus.fi

  

Article Information

Published online: December 13, 2011
Number of Print Pages : 8
Number of Figures : 4,

  

Publication Details

Case Reports in Neurology

Vol. 3, No. 3, Year 2011 (Cover Date: September - December)

Journal Editor: Tatlisumak T. (Helsinki)
ISSN: NIL (Print), eISSN: 1662-680X (Online)

For additional information: http://www.karger.com/CRN


Article / Publication Details

First-Page Preview
Abstract of Published: December 2011

Published online: 12/13/2011
Issue release date: September – December

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 0

ISSN: (Print)
eISSN: 1662-680X (Online)

For additional information: http://www.karger.com/CRN


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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