Predicting procedure successful rate and 1-year patency after endovascular recanalization for chronic carotid artery occlusion by CT angiography

Lee, Chung-Wei; Lin, Yen‐Heng; Liu, Hon‐Man; Wang, Yufen; Chen, Ya-Fang; Wang, Jaw‐Lin

doi:10.1016/j.ijcard.2016.07.127

Cited by 32 publications

(31 citation statements)

References 31 publications

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“…Therefore, a distal embolic protection or proximal occlusion of CCA with occlusion balloon that could reverse blood flow was deployed to minimize the risk of embolic events in our study, so no embolic stroke or symptomatic stroke happened postoperatively. Among the patients with successful recanalization, the reocclusion rate at the 3-month followup was 2.3% (1/43), which is lower than that in some other studies (Lee et al, 2016;Jiang et al, 2019). However, the reason was presumably related to the shorter interval time after surgery.…”

Section: Discussioncontrasting

confidence: 52%

A Treatment Option for Symptomatic Chronic Complete Internal Carotid Artery Occlusion: Hybrid Surgery

et al. 2020

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Background: Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischemic attack and cerebral infarction. The majority of cases of symptomatic ICAO requires surgical treatment. In this study we performed an investigation of the efficacy and safety of hybrid surgery which is a surgical method for symptomatic chronic complete ICAO. Methods: Fifty-five patients with symptomatic chronic ICAO treated by hybrid surgery from 2016 to 2019 were included. We recorded and analyzed the patients' clinical characteristics, angiographic data, recanalization rate, complications, and outcomes. Catheter angiography or computed tomography angiography was used to assess the patency of the recanalized ICA during follow-up. Results: The total success rate of recanalization was 78.2% (43/55). The occlusions were significantly shorter in the success than failure group (5.40 ± 1.50 vs. 7.56 ± 0.99 cm, respectively; P < 0.001). The median duration of ICA occlusion was significantly shorter in the success than failure group (90 vs. 200 days, respectively). The success rates of distal ICA recanalization at the petrous segment or below, cavernous segment, and clinoid segment or above were 100, 33.3, and 14.3%, respectively (P < 0.001). Multivariate analysis showed that the level of distal ICA reconstitution was the only factor affecting the recanalization success rate. Periprocedural complications included hyperperfusion syndrome (n = 1) and laryngeal nerve injury (n = 1). ICA reocclusion occurred in one patient (2.3%). Significant postoperative improvement in symptoms was observed in the success group, with a median modified Rankin scale score of 0 at the 3-month follow-up compared with before recanalization (median, 1) (P<0.001). Conclusion: Hybrid surgery might be safe and effective for patients with symptomatic chronic complete ICAO. The level of distal ICA reconstitution is a predictor of successful recanalization in hybrid operations.

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Section: Discussioncontrasting

confidence: 52%

A Treatment Option for Symptomatic Chronic Complete Internal Carotid Artery Occlusion: Hybrid Surgery

et al. 2020

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“…A major problem that affects the prognosis of CTO of ICA is the presence of reocclusion following recanalization. It is considered that maintenance of the recanalization mainly depends on the occlusion site; in a previous study, the rates of reocclusion within 1 year were 91% in those with occlusions distal to the clinoid segment and 0% in those with occlusions proximal to the clinoid segment ( 12 ).…”

Section: Prognosismentioning

confidence: 99%

“…As these techniques are relatively immature, the risks of the intervention are typically greater than the benefits, and the curative effects are not ideal. However, the development of these techniques and the emergence of hybrid surgery in recent years has provided novel options for treating CTO of the ICA, and the success rate has gradually improved ( 12 ). Nonetheless, controversy regarding appropriate therapeutic approaches for CTO of the ICA remains to be an issue.…”

Section: Introductionmentioning

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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“…Hasan et al 7 identified four types of radiographic COICA, reported as the ICA with occlusion involving the cavernous or supraclinoid portions, presenting 25% cases of successful recanalization and 25% cases of complications, compared with an 80% success rate and 15% of complications of more proximal lesions. Similarly, Lee et11 reported a 52% success rate and 22% of adverse events for chronic occlusion at (or distal to) the clinoid segment, and an 89% success without major complications for occlusions proximal to the clinoid portion.…”

Section: Discussionmentioning

confidence: 81%

“…Eleven studies were retrospective series,6 7 9–17 one study had a prospective design,18 and one was done from a prospective registry 4. Overall, 10 articles4 7 9 10 12–16 18 were rated as high-quality studies based on the Newcastle-Ottawa quality assessment criteria (online supplementary table 3).…”

Section: Resultsmentioning

confidence: 99%

Endovascular recanalization of chronically occluded internal carotid artery

Cagnazzo¹,

Lefevre²,

Derraz³

et al. 2020

J NeuroIntervent Surg

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BackgroundIt is debated whether endovascular treatment is indicated for a symptomatic chronically occluded internal carotid artery (COICA).ObjectiveTo assess outcomes after endovascular treatment of COICA.MethodsWe performed a systematic search of three databases (PRISMA guidelines), including endovascular series of COICA. Outcomes were analyzed with random-effects models.ResultsWe included 13 studies and 528 endovascularly treated patients with COICA. Successful recanalization was 72.6% (347/528, 95% CI 65.4% to 79.9%, I2=68.9%). Complications were 18% (88/516, 95% CI 12.1% to 23.8%, I2=65%), with 5% (25/480, 95% CI 2% to 7%, I2=0%) of permanent events, and 9% (43/516, 95% CI 6% to 13%, I2=34%) of thromboembolisms. Treatment-related mortality was 2% (11/516, 95% CI 0.5% to 2.6%, I2=0%). Shorter duration of the occlusion was associated with higher recanalization: 80% (11/516, 95% CI 54% to 89%, I2=0%), 63% (33/52, 95% CI 49% to 76%, I2=0%), and 51% (18/35, 95% CI to 37% to 88%, I2=40%) recanalization rates for 1, 3, and >3 months occlusions, respectively. Complications were 6% (3/50, 95% CI 3% to 21%, I2=0%), 14% (4/27, 95% CI 5% to 26%, I2=0%), and 25% (13/47, 95% CI 10% to 30%, I2=0%) for 1, 3, and >3 months occlusions, respectively. Patient aged <70 years presented higher revascularization rates (OR=3.1, 95% CI 1.2 to 10, I2=0%, p=0.05). Successful reperfusion was higher (OR=5.7, 95% CI 1.2 to 26, I2=60%, p=0.02) and complications were lower (OR=0.2, 95% CI 0.6 to 0.8, I2=0%, p=0.03) for lesions limited to the cervical internal carotid artery compared with the petrocavernous segment. Successful recanalization significantly lowered the rate of thromboembolisms (OR=0.2, 95% CI 0.8 to 0.6, I2=0%, p=0.01) and mortality (OR=0.5, 95% CI 0.1 to 0.9, I2=0%, p=0.04), compared with conservative treatment.ConclusionsEndovascular treatment of COICA gives a 70% rate of successful recanalization, with 5% morbidity. Patients aged <70 years, lesions limited to the cervical internal carotid artery, and a shorter duration of the occlusion decreased the risk of complications. Successful recanalization of symptomatic lesions lowered by about 80% the likelihood of thromboembolisms, compared with medical management.

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Predicting procedure successful rate and 1-year patency after endovascular recanalization for chronic carotid artery occlusion by CT angiography

Cited by 32 publications

References 31 publications

A Treatment Option for Symptomatic Chronic Complete Internal Carotid Artery Occlusion: Hybrid Surgery

A Treatment Option for Symptomatic Chronic Complete Internal Carotid Artery Occlusion: Hybrid Surgery

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

Endovascular recanalization of chronically occluded internal carotid artery

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