HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nedeltchev, K. Articles by Schroth, G. Search for Related Content PubMed PubMed Citation Articles by Nedeltchev, K. Articles by Schroth, G.

Internal Carotid Artery Stent Implantation in 25 Patients with Acute Stroke: Preliminary Results¹

¹ From the Institute of Diagnostic and Interventional Neuroradiology (K.N., C.B., L.R., C.O., G.S.), Clinic of Angiology (D.D.D.), and Clinic of Neurology (M.A., H.P.M.), University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland. Received September 20, 2004; revision requested November 24; revision received December 20; accepted January 27, 2005. Supported in part by a grant from the Swiss National Science Foundation (SNF 3100-66348.01). Address correspondence to G.S. (e-mail: gerhard.schroth{at}insel.ch).

View larger version (104K): [in a new window]   Figure 1a. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (90K): [in a new window]   Figure 1b. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (135K): [in a new window]   Figure 1c. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (139K): [in a new window]   Figure 1d. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (160K): [in a new window]   Figure 1e. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (150K): [in a new window]   Figure 1f. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (143K): [in a new window]   Figure 1g. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (71K): [in a new window]   Figure 1h. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (155K): [in a new window]   Figure 1i. Images obtained in 65-year-old man with right-sided hemiparesis and aphasia. (a, b) MR images demonstrate widespread mismatch between extent of lesion (arrows) on (a) transverse apparent diffusion coefficient maps and (b) transverse time-to-peak maps. (c) Lateral angiogram of right common carotid artery reveals high-grade stenosis of ICA (arrow). (d) Frontal angiogram demonstrates hypoplasia of A1 segment (arrow) of right anterior cerebral artery that precludes cross flow through anterior communicating artery. (e, f) Lateral angiograms of left common carotid artery show (e) occlusion of left ICA (arrow) and (f) subtle filling of carotid siphon through anastomoses of external carotid and ophthalmic arteries (arrowheads). (g) Lateral roadmap angiogram demonstrates infusion catheter, which is introduced into origin of left MCA (arrowhead), and 8-F guide catheter, which is placed at horizontal petrous segment of ICA (arrow). (h) Image of aspirated white and red thrombus. (i) Frontal angiogram of left common carotid artery demonstrates implantation of tapered nitinol carotid stent, which resulted in normal flow in ICA, anterior cerebral artery, and MCA.

View larger version (133K): [in a new window]   Figure 2a. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (104K): [in a new window]   Figure 2b. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (140K): [in a new window]   Figure 2c. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (147K): [in a new window]   Figure 2d. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (106K): [in a new window]   Figure 2e. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (224K): [in a new window]   Figure 2f. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (144K): [in a new window]   Figure 2g. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (142K): [in a new window]   Figure 2h. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.

View larger version (142K): [in a new window]   Figure 2i. Images of 66-year-old man with right-sided hemiplegia, aphasia, and subsequent craniocerebral trauma. (a) Transverse CT scan obtained 2 hours after symptom onset demonstrates small hemorrhagic contusions (arrowheads) that prevent pharmacologic thrombolysis. (b, c) Perfusion CT scans show (b) prolongation of mean transit time of contrast material (arrow) and (c) critically reduced cerebral blood flow in territory of left MCA (arrow). Cerebral angiography performed 2 hours after onset of symptoms revealed high-grade stenoses of right ICA and vertebral arteries (not shown). (d) Lateral angiogram of the left common carotid artery demonstrates occlusion of left ICA (arrow). (e) Lateral angiogram obtained after contrast material injection through guide catheter (with tip of infusion catheter in petrous segment) demonstrates occlusion of cavernous segement of ICA (arrow). (f) Image demonstrates shape of aspirated thrombus, which fits that of occluded segments of ICA and MCA. (g, h) Lateral angiograms obtained after contrast material injection through guide catheter demonstrate (g) revascularization of ICA, MCA, and anterior cerebral artery and (h) subsequent carotid artery stent implantation (arrow), with distal protection of filter wire (arrowhead). (i) Final frontal angiogram demonstrates normal blood flow through stent and through branches of left ICA.