Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safety, a modified radiographic classification system, and clinical outcomes

Mo, Liumei; Ma, Guixian; Dai, Chengbo; Wang, Shuo; Li, Changmao; Ma, Tengyun; Yang, Zhexian; He, Chi-zhong; Hao, Xiaoyan; Wang, Limin; Duan, Jinhai; Zhang, Yuhu

doi:10.1007/s00234-020-02458-0

Cited by 14 publications

(14 citation statements)

References 24 publications

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“…Recently, endovascular revascularization was reported to have a 70% success rate, with a 13% complication rate and 5% morbidity (8)(9)(10). However, technical skills are required for complex occluded vessels, such as complicated routes, collapsed vessel walls, propagated thrombi, and vulnerable plaques.…”

Section: Introductionmentioning

confidence: 99%

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA

Liu

Meng

et al. 2021

Front. Neurol.

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Objectives: To investigate the predictive factors for successful recanalization based on digital subtraction angiography and three-dimensional T1W sampling perfection with application-optimized contrasts using different flip angle evolutions (3D T1-SPACE) high-resolution magnetic resonance imaging (MRI) signal features.Methods: Consecutive internal carotid artery occlusion cases with ipsilateral ischemic stroke refractory to therapy who visited our institution between February 2017 and August 2020 were retrospectively analyzed. Epidemiology, symptomatology, imaging morphology on angiography and MRI, peri-procedural complications, technical success rate, and follow-up results were summarized. Factors related to technical success were analyzed using univariate and multivariate analyses.Results: In total, 75 cases (53 men, mean age 57.51 ± 9.71 years) were included. The total successful recanalization rate was 72.00% (54/75), with a complication rate of 13.33% (9/75). Through multivariate analysis, first ischemic stroke in <3 months (OR: 2.57; 95% CI: 1.13–4.58), tapered stump (OR: 4.31; 95% CI: 1.37–13.55), reversed flow of the ophthalmic artery (OR: 2.99; 95% CI: 1.06–8.49), high intraluminal signal on unenhanced T1-SPACE sequence (OR: 16.15; 95% CI: 3.40–76.72), no vessel wall collapse (OR: 17.00; 95% CI: 3.57–81.02), short occlusion length (OR: 9.87; 95% CI: 2.09–46.64), and primary occlusion site at the cervical internal carotid artery (OR: 8.42; 95% CI: 1.04–68.19) were associated with successful recanalization.Conclusion: Besides traditional features such as short ischemic event time, tapered stump, and distal ICA reconstitution by the ophthalmic artery, our study demonstrates that luminal and mural changes determined by 3D SPACE high-resolution MRI could also predict successful endovascular recanalization. Endovascular recanalization for non-acute internal carotid artery occlusion is feasible, but prudent case selection is mandatory considering the high periprocedural complication rate.

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Section: Introductionmentioning

confidence: 99%

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA

Liu

Meng

et al. 2021

Front. Neurol.

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“…Type D is that there is no recognizable proximal lumen, and there is no blood ow lling in the distal cavernous sinus segment and petrous segment. This classi cation does not include cases where there is an identi able lumen at the proximal end, there is no blood ow lling in the distal cavernous sinus segment and petrous segment, and simple ocular segment or communicating segment occlusion [13,14]. In addition, there is no essential difference between types A and B.…”

Section: Discussionmentioning

confidence: 99%

“…Hasan et al [13] classi ed the patients according to the shape of the occluded proximal stump and the blood ow lling site of the occluded distal stump. In Hasan et al [13], the success/complications rates were 100%/0% for group A, 100%/13% for group B, 50%/38% for group C, and 25%/25% for group D. Mo et al [14] improved the classi cation by Hasan et al [13]. In Mo et al [14], the success rates were 90% for group A, 70% for group B, 91% for group C, and 0% for group D.…”

Section: Introductionmentioning

confidence: 99%

New radiographic classification of endovascular recanalization of symptomatic non-acute carotid artery occlusion

Yan

Guo

et al. 2022

Preprint

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Purpose: To propose a new imaging classification based on cerebral angiography to determine the segment and length of occlusion and the condition of the proximal and distal lumen of the occluded segment.Methods: This retrospective study included patients with non-acute carotid artery occlusion (NACAO) who visited XXX Hospital (01/2017-12/2020). The lesions were classified according to the segment and length of carotid artery occlusion and the proximal and distal lumen of the occluded segment. Results: Type IV is not recommended for endovascular recanalization, and patients with types I (10/24, 41.7%), II (7/24, 29.2%), and III (7/24, 29.2%) were included. The recanalization success rate was 87.5% (21/24; Type I, 10/10; Type II, 7/7; Type III, 4/7; P=0.017). The incidence of perioperative complications was 25.0% (6/24; Type I, 0/10; Type II, 2/7; Type III, 4/7; P=0.038). The re-occlusion rate was not significantly different among the three groups (P=0.284). The average modified Rankin Scale (mRS) score in the success group was lower than before operation (P=0.012), but not in the failure group (P=0.317). Conclusion: The new classification based on cerebral angiography is helpful to screen patients with drug-refractory NACAO with a high success rate and low complications of intra-tube recanalization.

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“…Patients who presented with CICAO on TOF-MRA or CTA and underwent both HR-MRI and DSA examinations were included in the study. The detailed inclusion criteria included ( 1 ) recanalization attempts were performed; ( 2 ) the time interval between HR-MRI and DSA was within 2 weeks; ( 3 ) HR-MRI cover the whole ICA from the bifurcation of the common carotid artery to the body of the corpus callosum; ( 4 ) the image quality of HR-MRI was adequate for evaluation; and ( 5 ) patients had one or more traditional atherosclerotic risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, and current cigarette smoking. The exclusion criteria included ( 1 ) pseudo-occlusion, defined as an extremely narrow residual lumen with a string-like or more normal distal lumen ( 14 ), or severe stenosis diagnosed by DSA; ( 2 ) history of surgery between HR-MRI imaging and DSA; ( 3 ) insufficient ICA coverage or uninterpretable images due to motion artifacts; and ( 4 ) nonatherosclerotic vasculopathies, such as vasculitis, dissection, or moyamoya disease.…”

Section: Methodsmentioning

confidence: 99%

“…The optimal treatment of CICAO is still unclear. Endovascular recanalization has been reported as an effective treatment for CICAO ( 3 , 4 ). Successful recanalization reconstructs normal intracranial perfusion, alleviates clinical symptoms, and restores neurocognitive function ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

High-resolution magnetic resonance imaging for predicting successful recanalization in patients with chronic internal carotid artery occlusion

et al. 2022

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ObjectiveThe main aim of the study was to investigate the predictive factors of high-resolution magnetic resonance imaging (HR-MRI) for successful recanalization in patients with chronic internal carotid artery occlusion (CICAO).MethodsWe included 41 consecutive patients who had CICAO and underwent recanalization attempts. The demographics, clinical data, and HR-MRI features in relation to the technique success were collected and analyzed using univariate and multivariate analyses. A score-based prediction model was constructed using a regression coefficient-based scoring method.ResultsTechnical success was achieved in 26 (63.4%) patients, with a complication rate of 12.2% (5/41). Based on multivariate analysis, occlusions involving ophthalmic artery segment (C6) or above (OR: 0.036; 95% confidence interval [CI]: 0.004–0.336) and nontapered stump (OR: 0.064; 95% CI: 0.007–0.591) were identified as independent negative predictors of successful recanalization in patients with CICAO. Point scores were assigned according to the model coefficients, and the patients who scored 0, 1, or 2 points had success rates of 93.33% (14/15), 66.67% (12/18), or 0% (0/8), respectively.ConclusionHR-MRI characteristics may be valuable in identifying candidates for endovascular recanalization in patients with CICAO. Occlusions involving the C6 segment or higher, as well as nontapered stumps, were independent negative predictors of technical success.

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Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safety, a modified radiographic classification system, and clinical outcomes

Cited by 14 publications

References 24 publications

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA

Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA

New radiographic classification of endovascular recanalization of symptomatic non-acute carotid artery occlusion

High-resolution magnetic resonance imaging for predicting successful recanalization in patients with chronic internal carotid artery occlusion

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