Emergent Combined Intracranial Thrombolysis and Carotid Stenting in the Hyperacute Management of Stroke Patients with Severe Cervical Carotid Stenosis

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Fig 1.
A 65-year-old-man presented with aphasia and right hemiplegia with a NIHSS score of 22 despite IV tPA. The diagnostic angiogram shows a severe left cervical ICA stenosis (A) and a distal ICA occlusion involving both the left M1 and A1 segments (T-lesion) (B). Carotid stent placement with a 5 × 20-mm Precise stent was performed emergently. The angiographic result after the carotid stent placement is shown in C, and the angiograms at the midthrombolysis and the final recanalization phase are shown in D and E, respectively.

Clinical characteristics, treatments, and outcomes of 5 patients with stroke who had severe cervical carotid stenosis

Patient No. (Age/Sex)	Comorbidities	Time from Ictus to Endovascular Treatment (hr:min)	NIHSS at Admission	Site of Occlusion	Treatment					Complications	Length of Hospital Stay (days)	NIHSS at Discharge	Discharge Disposition	Outcome
Patient No. (Age/Sex)	Comorbidities	Time from Ictus to Endovascular Treatment (hr:min)	NIHSS at Admission	Site of Occlusion	IV tPA	IA tPA (mg)	IA ReoPro (mg)	IV ReoPro	Cervical ICA Stent Size (mm)	Complications	Length of Hospital Stay (days)	NIHSS at Discharge	Discharge Disposition	Outcome
1 (65/M)	HTN, MI	4	22	L ICA >90% stenosis; L tICA, M1, and A1 segment occlusion (T lesion)	Yes	10.5	25	Yes	5 × 20 with 10% residual stenosis	None	4	3	Home	6 months: no restenosis; 6 months: mRS^a 0
2 (63/M)	HTN	4	7	R ICA >95% stenosis; R M2 and M3 segment occlusion	No	5	No	Yes	7 × 30 with no residual stenosis	None	4	2	Home	6 months: no restenosis; 8 months: mRS 1
3 (66/M)	HTN	5:09	11	L ICA >95% stenosis; L M1 segment occlusion	Yes	15	20	yes	8 × 40 with 15% residual stenosis	None	3	0	Home	3 months: no restenosis; 6 months: mRS 0
4 (53/M)	CAD, HTN	3:40	8	R ICA >95% stenosis; R M1, M2, and R A1, A2 segment occlusion	No	11	No	Yes	6 × 40 with no residual stenosis	None	5	2	Home	18 months: no restenosis; 24 months: mRS 0
5 (65/M)	None	5:13	21	L ICA >95% stenosis; L M1, M2 segment occlusion	Yes	3.5	No	Yes	8 × 30 with 20% residual stenosis	R groin pseudoaneurysm; in-stent thrombosis; death	16	N/A	N/A	Death

Note:—NIHSS indicates National Institutes of Health Stroke Scale; IV, intravenous; IA, intra-arterial; tPA, tissue plasminogen activator; L, left; R, right; ICA, internal carotid artery; HTN, hypertension; MI, myocardial infarction; tICA, terminal internal carotid artery; mRS, modified Rankin Scale; CAD, coronary artery disease.
a mRS scores are defined as follows: 0, no symptoms; 1, no significant disability despite symptoms—able to perform usual duties and activities; 2, slight disability—unable to perform all previous activities but able to look after own affairs without assistance; 3, moderate disability—requires some help, but able to walk without assistance; 4, moderately severe disability—unable to walk without assistance and unable to attend to own bodily needs without assistance; 5, severe disability—bedridden, incontinent, and requires constant nursing care and attention.