Endovascular Revascularization for Acute Stroke

University of Pittsburgh (Pittsburgh, PA, USA) researchers report a high level of effectiveness in re-opening completely blocked internal carotid arteries (ICA) as late as two to three days after acute stroke symptoms by using stents and angioplasty. Early restoration of flow in the occluded ICA may improve the symptoms of acute stroke, prevent worsening, and reduce long-term stroke recurrence risk.

The study at the University of Pittsburgh School of Medicine's department of neurology and University of Pittsburgh Medical Center's (UPMC) Stroke Institute was published in the November 2005 issue of Stroke, a publication of the American Heart Association (Dallas, TX, USA).

"This report breaks new ground in that it contradicts the conventional wisdom that a completely blocked or occluded carotid cannot be opened,” observed the study's lead author, Tudor Jovin, M.D., assistant professor of neurology and neurosurgery at Pitt's School of Medicine and co-director of the Center for Endovascular Therapy at UPMC.

"The main finding of the report was that endovascular revascularization of occluded ICA in the setting of acute or subacute ischemic stroke carries a high-revascularization rate and is safe in selected patients,” said Dr. Jovin.

"Management of stroke because of acute internal carotid artery occlusion continues to represent a challenge because it may result in significant disability in 40% and death in 20% of cases,” Dr. Jovin added. "Our results are significant because they offer an opportunity for patients who may need more aggressive treatment. Future prospective studies are necessary to determine which patients are most likely to benefit from this form of therapy.”

The study also demonstrated that ideal candidates for endovascular ICA revascularization would be patients with a small area of tissue irreversibly compromised and a large area of tissue that is viable but threatens to undergo infarction.