Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion

Abstract

Background-Patients with chronic cervical internal carotid artery occlusion (ICAO) and cerebral ischemia may benefit from revascularization. The feasibility of endovascular recanalization for chronic ICAO has been reported recently, but its safety is still unproven. We report the follow-up results of 54 chronic ICAO patients who underwent endovascular recanalization, focusing on potential vascular complications and corresponding management. Methods and Results-Endovascular recanalization for chronic ICAO was attempted in 54 consecutive patients (48 men; 69.2Ϯ9.8 years old) with either recurrent neurological deficit or objective ipsilateral hemisphere ischemia. Mean duration from occlusion documentation to the procedure was 237Ϯ327 days (range, 56 to 1424 days). Adverse events while in the hospital and during the 3-month follow-up were recorded. Successful recanalization was achieved in 35 of 54 patients (65%). Three-month cumulative stroke and death rate was 4% (2 of 54), including 1 in-hospital fatal nonipsilateral stroke and 1 in-hospital minor ipsilateral stroke secondary to systemic hypotension. Vascular complications developed in 3 of 54 patients (6%), including 1 late pseudoaneurysm formation 3 months after recanalization, 1 immediate carotid-cavernous fistula after recanalization, and 1 minor extravasation at carotid bifurcation after failed recanalization. However, no clinical sequela was noted with close follow-up and adequate management. Conclusion-Certain immediate or delayed vascular complications may develop during or after the endovascular recanalization for chronic ICAO. Although periprocedural death and stroke rate is limited in our study, further study combining neuroimaging tools and cognitive function evaluation is mandatory to assess its utility and appropriateness in patients with chronic ICAO. (Circ Cardiovasc Intervent. 2008;1:119-125.)

Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia

“…11,12 To the best of our knowledge, the present series is the first report demonstrating cognitive function improvement after stenting in chronic ICAO patients with objective hemisphere ischemia. In addition, some of the confounding factors associated with cognitive outcome after surgical revascularization may have been clarified in our series.…”

“…The definition of ICAO, premedication before the procedure, and details of the interventional technique have been described previously. 11,12 Technical success was defined as implantation of stents after recanalization of the occlusion, with a final residual diameter stenosis Ϲ20% and Thrombolysis in Myocardial Infarction grade 3 antegrade flow. All patients were sent to the intensive care unit for overnight hemodynamic and neurologic monitoring, where systolic blood pressure was carefully maintained between 100 and 140 mm Hg.…”

“…11,12 We report for the first time the results of short-term effects of carotid artery stenting on neurocognitive function in patients with chronic ICAO and objective cerebral ischemia.…”

Stenting of the Stenotic Common Carotid Artery Ostium by the Buddy Wire Technique: A Case Report

“…Therefore, we did not select the procedure. Next, endovascular recanalization of the completely occluded internal carotid artery would have been another option, [15][16][17] but this procedure involves the risk of damaging the internal carotid artery, and its success rate is about 70%. 16,17) We also avoided this procedure because the intracranial extradural internal carotid artery on the distal side was not visualized on MRA, and because the time of occlusion was unclear.…”

Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery

“…We know that some of these patients will continue to have symptoms and may go on to experience a stroke while on medical therapy. 8 In this issue of Circulation: Cardiovascular Interventions, Lin et al 9 provide us with the first glimpse of the possible role of carotid stenting for patients with this difficult clinical problem. They attempted recanalization of chronic internal carotid occlusion in 54 patients, 87% of whom were symptomatic, with a technical success rate of 65% (35/54).…”