Carotid intervention in acute stroke

With advances in acute stroke management, patients with symptomatic severe carotid stenosis are frequently evaluated in the acute stage (ie, within the first few hours) after onset of symptoms. Patients with severe extracranial carotid artery stenosis presenting with acute stroke often have associated intracranial occlusive lesions. When invasive intra-arterial therapy is indicated, both revascularization of the extracranial and of the intracranial occlusive lesion is warranted to achieve a good functional outcome. In patients presenting with acute stroke, revascularization of severe extracranial carotid stenosis and even frank occlusion is possible; it improves distal flow and allows easier access to the often coexistent intracranial occlusion. In this article, the authors review the indications, techniques, and results of acute carotid interventions for acute stroke.