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Current Atherosclerosis Reports

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01-10-2017 | Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)

Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

Authors: Konark Malhotra, Nitin Goyal, Georgios Tsivgoulis

Published in: Current Atherosclerosis Reports | Issue 10/2017

Abstract

Purpose of Review

Acute internal carotid artery occlusion (ICAO) is associated with large infarcts and poor clinical outcomes and contributes to morbidity and mortality worldwide. In this review, we discuss various etiologies and pathophysiology of clinical presentations of ICAO, different radiographic patterns, and management of patients with ICAO.

Recent Findings

Recanalization rates remain suboptimal with systemic thrombolysis amongst patients with acute ICAO. Recent success of endovascular therapy for vessel occlusion in anterior circulation has expanded the horizons; however, few patients with cervical dissections and ICAO were included in these landmark trials.

Summary

Acute ICAO responds poorly to intravenous thrombolysis and portends worse clinical outcomes. Extracranial and intracranial ICAOs have varied clinical course and imaging patterns, with discrete cervical ICAO usually associated with better clinical outcomes while tandem occlusions predispose poor outcomes. Diagnostic catheter-based angiogram is often required since appearances of ICAO using non-invasive neuroimaging modalities are often deceiving. Repeated vascular imaging in acute to subacute phase to determine recanalization of ICAO is critical for secondary prevention. Recent success of endovascular procedures will continue to expand the horizons to improve the management of ICAO.

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Title: Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management
Authors: Konark Malhotra
Nitin Goyal
Georgios Tsivgoulis
Publication date: 01-10-2017
Publisher: Springer US
Published in: Current Atherosclerosis Reports / Issue 10/2017
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-017-0677-7

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