http://www.springerlink.com/content/64rr0h3827k1g5p7/

Patients with acute stroke with large vessel occlusion and carotid stenosis have been stented and then thrombolysed, or the stenosis simply left as it is, in the past. However, a problem arises if a visible clot sticks in the lumen at the stenotic site. No need to worry. You can stent this as well and then perform thrombolysis, as done by the authors of this paper. Of course one needs to use a distal filter device!

Abstract

Introduction 

Carotid stenosis with intraluminal thrombus is associated with a high risk of early recurrent stroke. We evaluated the feasibility and outcome of carotid stenting in acute ischemic stroke patients with carotid stenosis and intraluminal thrombus.

Methods 

Among 295 consecutive acute ischemic stroke patients who were referred for intra-arterial thrombolytic (IAT) therapy, six patients with carotid stenosis and intraluminal thrombus were treated by stent assisted angioplasty. The clinical characteristics, feasibility, and clinical outcomes were assessed.

Results 

All patients had severe stenosis of the underlying carotid bulb (mean, 86.8%; range, 71–99%) with adjacent intraluminal thrombus. Stent assisted angioplasty resulted in successful recanalization in all six patients. Thrombus was captured with the filter device in four patients. Three patients with tandem occlusion of the ipsilateral proximal middle cerebral artery were successfully recanalized with intra-arterial urokinase. No patients suffered procedure related complications or symptomatic hemorrhage. Four patients showed good long-term outcome (3 month mRS; 0–2).

Conclusions 

Stent assisted angioplasty is a feasible treatment option for acute ischemic stroke patients caused by carotid stenosis with intraluminal thrombus and may be effective in preventing early recurrent stroke.

Keywords  Carotid stenosis – Angioplasty – Stent – Thrombolytic therapy