Department of Neurology, West Virginia University - Charleston Division, Charleston Area Medical Center, Charleston, WV, 25301, USA.
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
Curr Atheroscler Rep. 2017 Aug 31;19(10):41. doi: 10.1007/s11883-017-0677-7.
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.
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. 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.
急性颈内动脉闭塞（ICAO）与大梗死灶和不良临床结局相关，并导致全球发病率和死亡率升高。在这篇综述中，我们讨论了 ICAO 的各种病因和发病机制、临床表现、不同的影像学表现以及 ICAO 患者的管理。
急性 ICAO 患者接受全身溶栓治疗后的再通率仍不理想。血管内治疗在前循环血管闭塞中的成功应用扩大了治疗范围；然而，这些里程碑式的试验中很少包括颈椎夹层和 ICAO 的患者。急性 ICAO 对静脉溶栓反应不佳，预示着更差的临床结局。颅外和颅内 ICAO 的临床病程和影像学表现不同，单纯颈内动脉 ICAO 通常与更好的临床结局相关，而串联闭塞则预示着不良结局。由于非侵入性神经影像学检查对 ICAO 的显示往往具有欺骗性，因此通常需要进行基于导管的血管造影诊断。在急性至亚急性阶段进行重复血管成像以确定 ICAO 的再通对于二级预防至关重要。血管内治疗的最新成功将继续扩大治疗范围，以改善 ICAO 的管理。
