Protected Endovascular Revascularization of Subacute and Chronic Total Occlusion of the Internal Carotid Artery

Shojima, Masaaki; Nemoto, Shigeru; Morita, Akio; Miyata, Tomohiro; Namba, Katsunari; Tanaka, Yūko; Watanabe, Emiri

doi:10.3174/ajnr.a1843

Cited by 50 publications

(38 citation statements)

References 20 publications

(31 reference statements)

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Namba

Shojima²,

Nemoto

2012

Interv Neuroradiol

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During endovascular revascularization of subacute and chronic occlusion of the cervical internal carotid artery (ICA) it may be difficult to penetrate the lesion. Selecting the appropriate “true lumen”, a remnant of what had been the arterial lumen, at the initial step may facilitate the procedure. Because plaque at the carotid bifurcation is known to propagate from the posterior wall, a gateway to this “true lumen” should exist in the anterior side of the occluded stump. This hypothesis was studied retrospectively in our series of revascularizing ICA subacute and chronic occlusion. Eleven patients underwent endovascular revascularization for symptomatic cervical ICA occlusion. Procedures were performed by initially penetrating the occluded stump with a guidewire, followed by supporting catheter advancement through the occluded segment to secure the distal normal arterial lumen. Cases were analyzed with regard to the location of initial guidewire penetration. Eight patients underwent successful revascularization. In five cases, the entry point to the occluded stump was located at the anterior side, and in three, at the posterior side. Two posterior stump penetration cases were met with resistance in guidewire advancement, whereas penetration was smooth in the anterior cases. In addition, two posterior stump penetration cases resulted in contrast stasis in the posterior ICA wall. In our series of revascularizing cervical ICA subacute and chronic occlusion, initially targeting the anterior side of the occluded stump resulted in favorable results. This may be the result of selecting the “true lumen” at the beginning of the procedure.

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Section: Introductionmentioning

confidence: 99%

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

Namba

Shojima²,

Nemoto

2012

Interv Neuroradiol

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“…31,32 Prevention of subsequent stroke in patients with CAO remains a difficult challenge; revascularization techniques can be used to improve cerebral perfusion in an attempt to prevent ischemia, such as the extracranialintracranial (EC-IC) bypass surgery or endovascular techniques. 33 EC-IC bypass has also been shown to improve the CVR of patients following intervention, 34 and Mandell et al, 35 by using CO 2 BOLD fMRI, showed that preoperative CVR measurements could predict the hemodynamic effects of EC-IC bypass surgery. However, bypass surgery has been largely abandoned since the publication of a large negative randomized controlled trial in 1985, which showed no benefit to patients with CAO from a bypass operation.…”

Section: Discussionmentioning

confidence: 99%

“…39 In the future, it is likely that EC-IC bypass may be superseded by newer endovascular techniques for which there have been recent feasibility studies showing promising results by using a minimally invasive recanalization technique with proximal cerebral protection and stent placement for symptomatic acute and chronic carotid artery occlusion. 33 One of the main problems of using nuclear medicine-based techniques such as PET and SPECT to assess hemodynamic impairment is the relatively large dose of ionizing radiation to the patient in addition to cost and access. A method for assessment of cerebral hemodynamics without radiation risks is obviously preferable.…”

Section: Discussionmentioning

confidence: 99%

Impaired Cerebrovascular Reactivity Predicts Recurrent Symptoms in Patients with Carotid Artery Occlusion: A Hypercapnia BOLD fMRI Study

Goode

Altaf

Munshi

et al. 2016

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:A key factor in predicting recurrent ischemic episodes in patients with carotid artery occlusion is the presence of hemodynamic impairment. There is, however, no consensus on how to best assess this risk in terms of imaging modalities or thresholds used. Here we investigated whether a predefined threshold of hemispheric asymmetry in hypercapnia fMRI predicts recurrent symptoms in patients with carotid artery occlusion.

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“…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.…”

Section: Emerging Therapiesmentioning

confidence: 97%

Management of Patients With Atherosclerotic Carotid Occlusion

Powers

2011

Curr Treat Options Neurol

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• Patients with acute ischemic stroke due to atherosclerotic carotid artery occlusion (ACAO) should receive intravenous tissue plasminogen activator (alteplase) if they meet eligibility criteria of the National Institute of Neurological Disorders and Stroke (NINDS) or the European Cooperative Acute Stroke Study III (ECASS III). • Patients with acute stroke due to ACAO who are not eligible for intravenous tissue plasminogen activator should receive aspirin. Heparin or heparin-like drugs do not improve outcome and should not be used. • Therapy for prevention of recurrent stroke in patients with ACAO should consist of lifestyle modifications, risk factor intervention, and antiplatelet drugs. Warfarin is not indicated. • Extracranial-intracranial bypass surgery provides no benefit over medical therapy in preventing recurrent stroke in a general population of patients with ACAO or in any subgroups selected by clinical, arteriographic, or hemodynamic criteria. • Other surgical or endovascular procedures have no proven value in treating or preventing stroke due to ACAO. • Asymptomatic carotid occlusion has a benign prognosis and requires no specific treatment other than lifestyle modification and risk factor intervention.

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Protected Endovascular Revascularization of Subacute and Chronic Total Occlusion of the Internal Carotid Artery

Cited by 50 publications

References 20 publications

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

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

Impaired Cerebrovascular Reactivity Predicts Recurrent Symptoms in Patients with Carotid Artery Occlusion: A Hypercapnia BOLD fMRI Study

Management of Patients With Atherosclerotic Carotid Occlusion

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