Effects of endovascular recanalization on symptomatic non-acute occlusion of intracranial arteries

Xia, Jinchao; Gao, Huiping; Zhang, Kun; Gao, Bu-Lang; Li, Tianxiao; Wang, Ziliang

doi:10.1038/s41598-023-31313-4

Cited by 4 publications

(1 citation statement)

References 42 publications

(61 reference statements)

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“…At this time, most of the thrombi occluding the artery have become stable and organized. Recanalization at a time earlier than 3 weeks may encounter a fresh thrombus and new cerebral infarction, which may result in an increased risk of perioperative thrombus shedding, bleeding transformation, and stent reocclusion based on other studies 3 , 27 , 28 . Not all occlusions were detected at the time of occlusion because some patients may have good collateral compensation without causing relevant ischemic symptoms, which may result in the delay of detection and treatment.…”

Section: Discussionmentioning

confidence: 96%

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

Ren,

Xue,

Zhao

et al. 2023

Sci Rep

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To investigate the effect of endovascular and/or hybrid surgical recanalization on chronic long-segment occlusion of the internal carotid artery (ICA) and the effect of occlusion location on the recanalization rate and prognosis, 87 patients with chronic ICA occlusion treated with endovascular approach only or hybrid surgery were retrospectively enrolled. The duration of ICA occlusion ranged from 21 to 360 days (median 30). Type I occlusion (from the neck to below the cavernous segment) consisted of 46 (52.8%) patients while type II (from the neck to above the clinoid segment) of 41 (47.1%). Hybrid surgery was performed in 44 (50.6%) patients while endovascular recanalization only was conducted in the other 43 (49.4%). In all patients, the success rate of recanalization was 93.0% (40/43) for the endovascular approach and 95.5% for the hybrid surgical approach. In patients with type I occlusion, endovascular recanalization only was performed in 22 (47.8%) patients and hybrid surgery in 24 (52.2%), resulting in successful recanalization in all patients (100%). In patients with type II occlusion, the success rate of recanalization was 85.7% (18/21) for the endovascular approach only but 90% (18/20) for the hybrid surgery. The total success rate of recanalization was 94.3% (82/87) for all patients, 100% for type I occlusion, and 87.8% for type II occlusion. No significant (P = 0.12) differences existed in the recanalization rate between groups I and II. Clinical follow-up was performed in 82 (94.3%) patients 6–39 months (mean 16) after the surgery. Re-occlusion occurred in 0 in group I but in four (9.8%) in group II. The mRS was good with 0–2 in 38 (82.6%) patients in group I and in 27 (75%) patients in group II, with no significant (P = 0.78) difference. In conclusion, chronic long-segment ICA occlusion can be safely and efficiently recanalized with the endovascular and hybrid surgery. The location of ICA occlusion may have a critical role in determining the recanalization rate, and careful evaluation of the occlusion location may be helpful in increasing the prognosis of recanalization.

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Section: Discussionmentioning

confidence: 96%

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

Ren,

Xue,

Zhao

et al. 2023

Sci Rep

Self Cite

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Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery

Zhao,

Xu,

Xue

et al. 2024

Sci Rep

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To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6–48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.

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Impact of post-procedure stenosis on outcomes of patients with severe intracranial stenosis treated with intracranial stent placement

Nunna,

Ma,

Genovese

et al. 2024

J NeuroIntervent Surg

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BackgroundThe optimal target post-procedure stenosis after percutaneous angioplasty and stent placement (PTAS) for intracranial stenosis is unknown. We determined the effect of post-procedure stenosis after intracranial PTAS on subsequent clinical events in patients with severe symptomatic intracranial stenosis.MethodsWe categorized the severity of post-procedure stenosis as ‘<30%’, ‘30–49%’, and ‘≥50%’ among 207 patients who underwent PTAS in a multicenter randomized clinical trial. Outcomes included stroke or death within 72 hours and within 30 days, ipsilateral stroke beyond 30 days of treatment, and stroke or death within 30 days or stroke in the qualifying artery beyond 30 days (primary endpoint of the trial). Cox proportional hazards analysis was performed with adjustments for age, initial severity of stenosis, location of stenosis, and qualifying event. Kaplan-Meier curves were generated for the primary endpoint stratified by post-procedure stenosis with log-rank analysis.ResultsThe severity of post-procedure stenosis was categorized as <30%, 30–49%, and ≥50% in 112, 73, and 22 patients, respectively. Compared with patients with post-procedure stenosis <30%, there was no difference in the risk of primary endpoint among patients with post-procedure stenoses of 30–49% (hazards ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64 to 1.15) or those with ≥50% (HR 0.91, 95% CI 0.57 to 1.43). Log-rank analysis did not demonstrate a difference in rates of primary endpoint between groups stratified by post-procedure stenosis (P=0.70).ConclusionIn the absence of any benefit on short- and long-term outcomes, strategies to achieve a low severity of post-procedure stenosis among patients with severe intracranial stenosis may not be warranted.

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Effects of endovascular recanalization on symptomatic non-acute occlusion of intracranial arteries

Cited by 4 publications

References 42 publications

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery

Impact of post-procedure stenosis on outcomes of patients with severe intracranial stenosis treated with intracranial stent placement

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