Evaluation of stenosis using magnetic resonance angiography for acute cervical internal carotid artery occlusion initially treated by angioplasty alone: A case series.

BACKGROUND: The optimal treatment strategy for acute ischemic stroke following atherosclerotic cervical internal carotid artery (ICA) occlusion remains unclear. Angioplasty alone may increase the risk of re-occlusion and recurrent ischemic stroke. This study investigated imaging changes after performing angioplasty alone. METHODS: We retrospectively reviewed consecutive patients who underwent mechanical thrombectomy (MT) from 2017 to 2024. Patients who underwent angioplasty with atherosclerotic cervical ICA occlusion were initially screened. We performed MT, along with angioplasty for the cervical artery, during the acute procedure. Additional treatment (stenting or endarterectomy) was scheduled after a week or more. Magnetic resonance imaging was performed to assess the stenotic lesion. RESULTS: Of the 262 patients who underwent MT, 11 had atherosclerotic cervical ICA occlusion. Seven of them who underwent angioplasty alone were included in this study. Follow-up magnetic resonance angiography (MRA) showed a significant improvement in stenosis diameter compared with after the acute procedure (2.5 ± 0.5 mm vs. 2.0 ± 0.6 mm, p = 0.01). In patients who underwent delayed stenting, angiography showed no significant difference in the residual stenotic lesion (2.1 ± 0.7 mm vs. 1.9 ± 0.6 mm, p = 0.57). No re-occlusion, neurological deterioration, or symptomatic hemorrhage occurred. CONCLUSION: In appropriately selected patients treated with angioplasty alone, follow-up MRA showed a trend toward gradual improvement of the stenotic lesion without re-occlusion or neurological deterioration. MRA may be useful for non-invasive and repeated monitoring of stenotic changes over time.