Endovascular recanalization of the common carotid artery in a patient with radio induced chronic occlusion

Abstract

Recanalization of chronic occlusion of the common carotid artery (CCA) in patients with a history of neck irradiation is challenging, both for vascular surgeons and interventional neuroradiologists. We describe a case of successful stenting of radio induced chronic occlusion of the right CCA in a 41-year-old patient with neurological deterioration and minor stroke due to cerebral hypoperfusion caused by concomitant bilateral arterial occlusions. Direct surgery and surgical bypass were considered contraindicated. The endovascular approach was successful and required multiple precautions during the procedure. We describe particular solutions, not used in day to day practice, that allowed us to carry out the endovascular treatment in this unusual situation.

Sixteen years progress in recanalization of chronic carotid artery occlusion: A comprehensive review

“…Current literature mainly concerns occlusions caused by atherosclerosis. 34 cases (2.65%) of recanalization of radio induced occlusions presented with one particular case report [ 32 ] focused on technique and nuances of endovascular recanalization of radio induced CCAO. It should be noted that successful recanalization rate in this subgroup was lower than the average among studies (63.8 versus 76%) with higher rate of vascular complications (12.25 versus 8%).…”

“…Current literature mainly concerns occlusions caused by atherosclerosis. 34 cases (2.65%) of recanalization of radio induced occlusions presented with one particular case report 32) focused on technique and nuances of endovascular recanalization of radio induced CCAO.…”

“…In particular, Rostambeigi et al advocated using of ultrasound guidance to improve the outcome of the endovascular procedures in high-risk patients with carotid occlusion. 36) Nico et al 32) suggests using of echographic control to avoid the subintimal progression of the guidewire while entering the internal carotid at the end of the common carotid artery. Additionally, uncommon technique of a long dilatation balloon had been proposed for less traumatic, homogeneous dilata- Although complicated cases of CCAO could be challenging for ET, well-trained specialists have wide opportunities for interventions.…”

Combined endovascular antegrade- and direct retrograde carotid artery stenting for chronic and long segment common carotid artery occlusion: technical note and review of literature

“…Endovascular treatment for CCAO 1) Limited reports exist on antegrade and retrograde endovascular treatments for CCAO 4,5,7 . In reports of anterograde CAS for CCAO, the guide wire successfully passed through the occluded lesion via the catheter placed at the origin of the CCA 6-8 .…”

Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment

“…Previous studies revealed that CICAO is usually a result of complex hemodynamics, such as low shear stress, blood flow stasis, and blood flow separation (8,9). In addition, radiation therapy may cause chronic occlusion of the carotid artery (10). Of note, occlusion caused by carotid dissection mainly occurs in young individuals, and the pathogenic site is often at the entrance of hard vessels (11).…”