Letter to the Editor Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited.
Response to Letter Regarding Article, “Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke” We appreciate the interest of Zhou et al1 in our recently published article. They refer to an important issue about the acute treatment of an extracranial occlusion of the internal carotid artery (ICA) in patients with acute ischemic stroke. Our study was aimed at identifying a high-grade extracranial ICA stenosis after the acute phase in patients in whom an occluded extracranial ICA was found within the first hours after symptom onset. Because these patients are at risk for recurrent stroke, our results should be interpreted in the context of secondary prevention rather than in the context of acute treatment of ischemic stroke. We agree with the authors that more evidence is needed on the optimal treatment strategy for an extracranial ICA occlusion in patients with acute ischemic stroke who are eligible for endovascular treatment. On the basis of our study results, we share the experience of Zhou et al that stenting of the extracranial ICA is frequently performed simultaneously with endovascular treatment. In our study, 11 of 86 patients with an extracranial ICA occlusion underwent endovascular treatment. In 3 of these patients, endovascular treatment did not succeed. In the remaining 8 patients, stenting of the extracranial ICA was performed in combination with treatment with the proximal intracranial occlusion. In only 1 patient, a high-grade stenosis of the extracranial ICA remained after stenting. In the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study, 70 of 266 (26%) patients in the control group and 75 of 213 (32%) patients in the intervention group had an occlusion of the extracranial ICA, 30 of whom underwent stenting during the revascularization procedure.2 The
patients with an extracranial ICA occlusion showed a trend in favor of endovascular treatment in the acute stage (adjusted odds ratio, 1.43; 95% confidence interval 0.78–2.64).2 Until now, no details about residual high-grade extracranial ICA stenosis after endovascular treatment and subsequent functional outcome have been published by the MR CLEAN investigators. With regard to a potentially residual high-grade stenosis remaining after endovascular treatment, we emphasize the difference between acute treatment and secondary prevention. In case of acute intra-arterial treatment, a residual high-grade ICA stenosis is identified immediately and action can be taken on this finding directly. In patients with a residual high-grade ICA stenosis, which is identified after the acute stage, subsequent carotid surgery or stenting should be considered.
Disclosures None.
Merel J.A. Luitse, MD L. Jaap Kappelle, MD Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht, The Netherlands 1. Zhou W, Cui B, Lv H. Letter by Zhou et al regarding article, “Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke.” Stroke. 2015;46:e93. doi: 10.1161/ STROKEAHA.115.008834. 2. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. doi: 10.1056/NEJMoa1411587.
(Stroke. 2015;46:e94. DOI: 10.1161/STROKEAHA.115.008894.) © 2015 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.115.008894
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Response to Letter Regarding Article, ''Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke'' Merel J.A. Luitse and L. Jaap Kappelle Stroke. 2015;46:e94; originally published online March 5, 2015; doi: 10.1161/STROKEAHA.115.008894 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/46/4/e94
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
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Response to Letter Regarding Article, “Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke” We appreciate the interest of Zhou et al1 in our recently published article. They refer to an important issue about the acute treatment of an extracranial occlusion of the internal carotid artery (ICA) in patients with acute ischemic stroke. Our study was aimed at identifying a high-grade extracranial ICA stenosis after the acute phase in patients in whom an occluded extracranial ICA was found within the first hours after symptom onset. Because these patients are at risk for recurrent stroke, our results should be interpreted in the context of secondary prevention rather than in the context of acute treatment of ischemic stroke. We agree with the authors that more evidence is needed on the optimal treatment strategy for an extracranial ICA occlusion in patients with acute ischemic stroke who are eligible for endovascular treatment. On the basis of our study results, we share the experience of Zhou et al that stenting of the extracranial ICA is frequently performed simultaneously with endovascular treatment. In our study, 11 of 86 patients with an extracranial ICA occlusion underwent endovascular treatment. In 3 of these patients, endovascular treatment did not succeed. In the remaining 8 patients, stenting of the extracranial ICA was performed in combination with treatment with the proximal intracranial occlusion. In only 1 patient, a high-grade stenosis of the extracranial ICA remained after stenting. In the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study, 70 of 266 (26%) patients in the control group and 75 of 213 (32%) patients in the intervention group had an occlusion of the extracranial ICA, 30 of whom underwent stenting during the revascularization procedure.2 The
patients with an extracranial ICA occlusion showed a trend in favor of endovascular treatment in the acute stage (adjusted odds ratio, 1.43; 95% confidence interval 0.78–2.64).2 Until now, no details about residual high-grade extracranial ICA stenosis after endovascular treatment and subsequent functional outcome have been published by the MR CLEAN investigators. With regard to a potentially residual high-grade stenosis remaining after endovascular treatment, we emphasize the difference between acute treatment and secondary prevention. In case of acute intra-arterial treatment, a residual high-grade ICA stenosis is identified immediately and action can be taken on this finding directly. In patients with a residual high-grade ICA stenosis, which is identified after the acute stage, subsequent carotid surgery or stenting should be considered.
Disclosures None.
Merel J.A. Luitse, MD L. Jaap Kappelle, MD Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht, The Netherlands 1. Zhou W, Cui B, Lv H. Letter by Zhou et al regarding article, “Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke.” Stroke. 2015;46:e93. doi: 10.1161/ STROKEAHA.115.008834. 2. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. doi: 10.1056/NEJMoa1411587.
(Stroke. 2015;46:e94. DOI: 10.1161/STROKEAHA.115.008894.) © 2015 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org
DOI: 10.1161/STROKEAHA.115.008894
Downloaded from http://stroke.ahajournals.org/ by guest on June 25, 2016 e94
Response to Letter Regarding Article, ''Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke'' Merel J.A. Luitse and L. Jaap Kappelle Stroke. 2015;46:e94; originally published online March 5, 2015; doi: 10.1161/STROKEAHA.115.008894 Stroke is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://stroke.ahajournals.org/content/46/4/e94
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Stroke can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Stroke is online at: http://stroke.ahajournals.org//subscriptions/
Downloaded from http://stroke.ahajournals.org/ by guest on June 25, 2016
