Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safe
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INTERVENTIONAL NEURORADIOLOGY
Endovascular recanalization for symptomatic subacute and chronically occluded internal carotid artery: feasibility, safety, a modified radiographic classification system, and clinical outcomes Liumei Mo 1 & Guixian Ma 1 & Chengbo Dai 1 & Shuo Wang & Changmao Li 1 & Tengyun Ma 1 & Zhexian Yang 1 & Chizhong He 1 & Hao Xiao 1 & Lijuan Wang 1 & Jinhai Duan 1 & Yuhu Zhang 1 Received: 9 March 2020 / Accepted: 5 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the feasibility and safety of endovascular recanalization for symptomatic subacute and chronic internal carotid artery occlusion (ICAO); to propose a newly modified radiographic classification of ICAO that can rigorously identify suitable candidates for endovascular ICAO treatment. Methods We included 42 consecutive patients who had ICAO with ischaemic symptoms refractory to medical therapy. We examined the symptomatology, complications, follow-up results and radiographic images of ICAO receiving attempted endovascular treatment. We attempted to stratify all radiographic images into categories based on morphological occlusion patterns, occlusion segments and distal ICA reconstitution on digital subtraction angiography (DSA). Results Four types (A–D) of radiographic ICAO were identified. We redefined type B as having a tapered stump but no distal lumen. The rate of successful recanalization was 83.33% (35/42 ICAOs; type A, 18/20; type B, 7/10; type C, 10/11; type D, 0/1). The perioperative complication rate was 11.90% (5/42), including 3 asymptomatic distal embolisms, 1 symptomatic cerebral infarction and 1 asymptomatic carotid artery dissection. None of these technique-related complications led to severe neurological damage or death. Modified Rankin Scale (mRS) scores after 1–20 months of follow-up were significantly decreased in successfully revascularized patients (P < 0.001). There was no significant change in mRS scores in the 7 patients in whom recanalization failed (P > 0.05). Conclusions Endovascular recanalization seems to achieve technical success and clinical improvement for symptomatic subacute and chronic ICAO. Additionally, our newly modified radiographic classification of ICAO may be valuable in assessing the technical feasibility and safety of procedures in symptomatic ICAO patients. Keywords Symptomatic . Carotid . Occlusion . Stroke . Radiographic classification . mRS score
Introduction Even in patients who regularly receive the best available medication and have well-controlled risk factors, chronic internal carotid artery occlusion (ICAO) is closely related to a 6–20% risk of acute cerebral ischaemic events caused by compromised ipsilateral cerebral perfusion [1–4], and extracranialintracranial (EC/IC) arterial bypass surgery has been found to * Yuhu Zhang [email protected] 1
Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
have no benefit over medicati
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