Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage

Abstract

Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise or refractoriness to antiplatelet therapy, even in the subacute to chronic stage of the illness.

Wire-Probing Technique to Revascularize Subacute or Chronic Internal Carotid Artery Occlusion

“…More recently, a few reports demonstrated successful recanalization of chronically occluded carotid arteries with acceptable feasibility and safety [4][5][6][7][8][9][10] . however, this procedure can be difficult because there is no visualization of the route to guide the devices through the occluded segment.…”

Management of Patients With Atherosclerotic Carotid Occlusion

“…However, although it has long been assumed that a chronically occluded internal carotid artery cannot be opened, there have recently been a series of reports of endovascular revascularization of internal carotid arteries that have been occluded for as long as 4 years. Procedural complications have been low and hemodynamic improvement in the revascularized hemisphere has been demonstrated [42][43][44][45]. Whether these techniques prove to be beneficial in preventing subsequent stroke will require the performance of randomized clinical trials.…”

The Outcome and Efficacy of Recanalization in Patients with Acute Internal Carotid Artery Occlusion

“…34 Because there is no standardized recanalization technique for ICA occlusion in patients with acute stroke, mechanical and/or intra-arterial thrombolysis for intracranial occlusion has been followed by angioplasty and/or stent placement, aspiration thrombectomy, or clot retrieval with various devices. [9][10][11][12]35 Among the factors affecting good outcome, the effect of revascularization (postprocedural TICI grade) may depend on the methodology used to improve the final luminal patency for each occlusion type and level. Among those methods, protective flow arrest applies simple suction that effectively aspirates the clot and prevents distal migration to the intracranial vessels during clot retrieval.…”

“…The flow reversal technique or even manual neck compression may also be effective for protective proximal flow arrest. 9,12 Simple suction thrombectomy can be applied by using a proximal protection balloon with which the stent retriever is subsequently used. Extracranial-intracranial (ECIC) bypass surgery in patients with symptomatic occlusion of the ICA was illustrated by a new operating technique and patients without naturally occurring collateral flow to maintain adequate circulation might benefit from ECIC bypass surgery.…”

“…[6][7][8][9] Despite anecdotal endovascular attempts, an effective management approach has not been well established for patients with acute ICA occlusion that is not applicable to intravenous and/or intra-arterial thrombolysis. [10][11][12][13] The aims of the present study were to investigate the outcome and factors associated with recanalization therapy in acute occlusion of the ICA and to assess the efficacy of proximal flow arrest.…”