Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

Malhotra, Konark; Goyal, Nitin; Tsivgoulis, Georgios

doi:10.1007/s11883-017-0677-7

Cited by 43 publications

(51 citation statements)

References 79 publications

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“…If the CTO of the ICA is derived from atherosclerosis associated with calcification in the initial segment of the ICA, then severe atherosclerosis and calcification in the occluded segment may hinder the placement of the guidewire ( 113 ). Our experience is that for CTO of the ICA with recanalization, CTA or ultrasound inspection is often performed to judge whether severe atherosclerosis is present in the occlusion of the initial segment of the carotid artery.…”

Section: Factors Affecting Recanalizationmentioning

confidence: 99%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

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At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction. The majority of cases of CTO of the ICA require treatment. In early studies, the results of external-ICA bypass were unsatisfactory, while recanalization is now considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Endovascular interventional recanalization, carotid endarterectomy (CEA) and hybrid surgery may be conducted in a select group of patients. As novel materials are developed, the success rate of simple recanalization may gradually increase; however, hybrid surgery may be more representative of the current trend, as advanced CEA can remove carotid atherosclerosis plaques, thus reducing the technological demands of the subsequent interventional recanalization. There are many complications that may result from recanalization following CTO of the ICA, including hyperperfusion and technical errors; therefore, the operation must be conducted carefully. If the recanalization is successful, it typically results in a stable improvement of patient condition in the long term. However, despite these conclusions, more studies are required in the future to further improve current understanding of CTO of the ICA.

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Section: Factors Affecting Recanalizationmentioning

confidence: 99%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

biom rep

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“…Etiological factors for bilateral internal carotid artery occlusion include embolism, atherothrombosis, arterial dissection, vasospasm, and angitis. 2,11) In the presence of MRI-DWI the day after surgery. The hyperintensity areas in the insular cortex and parietal lobe of the right hemisphere, and a small area of the left hemisphere were larger than the areas before thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

Tsujimoto

Ikeda

Otsuka

et al. 2020

JNET

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We report a survived case of acute bilateral internal carotid artery occlusion successfully treated by mechanical thrombectomy. Case Presentation: The patient was an 82-year-old right-handed man. Sudden consciousness disturbance and aphasia appeared, and cranial magnetic resonance angiography (MRA) revealed bilateral internal carotid artery occlusion. Cerebral angiography demonstrated occlusion between the cervical and cavernous portions of the bilateral internal carotid artery, and the growth of collateral circulation to the areas where the bilateral internal carotid artery perfused. We performed mechanical thrombectomy first on the left side, which was the main cause of his symptoms and relatively wide ischemic penumbra, and achieved recanalization of the bilateral internal carotid artery and suppressed extensive enlargement of the infarction. Conclusion: Acute bilateral internal carotid artery occlusion requires an optimal treatment strategy based on the clinical symptoms and preoperative imaging. Keywords▶ internal carotid artery, occlusion, bilateral, thrombectomy, acute ischemic stroke Case Presentation The patient was an 82-year-old right-handed man with a history of rectal cancer. He had smoked 20 cigarettes/day and consumed alcohol every day. He was transferred to our hospital with dyspnea. While preparations were made for admission due to heart failure related to dilated cardiomyopathy, consciousness disorder and aphasia suddenly appeared. The Glasgow Coma Scale score was E2V2M5 and partial conjugate deviation to the left side was noted. The manual muscle testing scores were 3/5 for the bilateral upper limbs and right lower limb and 4/5 for the left lower limb, suggesting incomplete paralysis dominantly in the right side. Severe aphasia and unilateral carelessness were also observed. The National Institute of Health Stroke Scale (NIHSS) score was 20. Diffusion-weighted magnetic resonance imaging (MRI-DWI) at 140 minutes after onset revealed acute cerebral infarction of the area perfused by the bilateral middle cerebral arteries and right posterior cerebral artery. The DWI-Alberta Stroke Programme Early CT Score (ASPECTS) was 10 at both sides (Fig. 1A). Fluid-attenuated inversion recovery (FLAIR) imaging demonstrated little signal changes in the infarction area (Fig. 1B). Although occlusion of the bilateral internal This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…This is considered the main reason for the occurrence of an ischemic damage of brain areas during carotid dissection. 41 Moreover, several studies showed that ineffective collateral circles are present in patients with severe atherosclerosis. 42,43 The association between altered cerebral hemodynamic and cognitive dysfunction has been widely demonstrated in subjects with carotid stenosis.…”

Section: Follow-up Cognitive Assessmentmentioning

confidence: 99%

Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances

Viticchi

Falsetti

Buratti

et al. 2020

Int J Geriat Psychiatry

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The aim of this study was to investigate whether the presence of carotid artery occlusion (CO) may be associated with different cognitive performances in relation to the side of the occlusion and its hemodynamic consequences. Methods: During a 12-month period, 61 asymptomatic patients, 32 with right and 29 with left CO, were enrolled. Each patient underwent an assessment of cerebrovascular reactivity (CVR) to hypercapnia with transcranial Doppler (TCD) ultrasonography using the breath-holding index (BHI). Neuropsychological assessment evaluating performances of the hemisphere ipsilateral to CO were administered at entry (T 0) and then repeated after 2 years (T 1). Results: Scores obtained at colored progressive matrices (CPM) and Rey Complex Figure Copy Test were significantly lower at T 0 in patients with reduced BHI values ipsilateral to CO. Multivariate models showed that reduced BHI values were also associated to a significant decrease from T 0 to T 1 in scores obtained for CPM and Categorical Verbal Fluency tests, respectively, in patients with right (P = 0.002) or left CO (P = 0.004). Conclusions: These findings suggest that hemodynamic alterations could be involved in the reduction in cognitive function regulated by the hemisphere ipsilateral to CO. The assessment of CVR with TCD ultrasonography may be a reliable approach for the individuation of asymptomatic patients with CO at increased risk of cognitive deterioration.

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Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management

Cited by 43 publications

References 79 publications

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Current understanding of chronic total occlusion of the internal carotid artery (Review)

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances

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