Endovascular Recanalization of Tandem Internal Carotid Occlusions Using the Balloon-assisted Tracking Technique.

2021 ◽  
Author(s):  
Csaba Nagy ◽  
Júlia Héger ◽  
Gábor Balogh ◽  
István Gubucz ◽  
Sándor Nardai ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Tracking Technique ◽  
Endovascular Recanalization

scholarly journals Imaging Predictors for Endovascular Recanalization of Non-acute Occlusion of Internal Carotid Artery Based on 3D T1-SPACE MRI and DSA

2021 ◽  
Vol 12 ◽  
Author(s):  
Liu Chao ◽  
Meng Qingbin ◽  
Xu Haowen ◽  
Xie Shanshan ◽  
Fu Qichang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Resolution ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Technical Success ◽  
Endovascular Recanalization

Objectives: To investigate the predictive factors for successful recanalization based on digital subtraction angiography and three-dimensional T1W sampling perfection with application-optimized contrasts using different flip angle evolutions (3D T1-SPACE) high-resolution magnetic resonance imaging (MRI) signal features.Methods: Consecutive internal carotid artery occlusion cases with ipsilateral ischemic stroke refractory to therapy who visited our institution between February 2017 and August 2020 were retrospectively analyzed. Epidemiology, symptomatology, imaging morphology on angiography and MRI, peri-procedural complications, technical success rate, and follow-up results were summarized. Factors related to technical success were analyzed using univariate and multivariate analyses.Results: In total, 75 cases (53 men, mean age 57.51 ± 9.71 years) were included. The total successful recanalization rate was 72.00% (54/75), with a complication rate of 13.33% (9/75). Through multivariate analysis, first ischemic stroke in <3 months (OR: 2.57; 95% CI: 1.13–4.58), tapered stump (OR: 4.31; 95% CI: 1.37–13.55), reversed flow of the ophthalmic artery (OR: 2.99; 95% CI: 1.06–8.49), high intraluminal signal on unenhanced T1-SPACE sequence (OR: 16.15; 95% CI: 3.40–76.72), no vessel wall collapse (OR: 17.00; 95% CI: 3.57–81.02), short occlusion length (OR: 9.87; 95% CI: 2.09–46.64), and primary occlusion site at the cervical internal carotid artery (OR: 8.42; 95% CI: 1.04–68.19) were associated with successful recanalization.Conclusion: Besides traditional features such as short ischemic event time, tapered stump, and distal ICA reconstitution by the ophthalmic artery, our study demonstrates that luminal and mural changes determined by 3D SPACE high-resolution MRI could also predict successful endovascular recanalization. Endovascular recanalization for non-acute internal carotid artery occlusion is feasible, but prudent case selection is mandatory considering the high periprocedural complication rate.

Endovascular recanalization of chronically occluded internal carotid artery

2020 ◽  
Vol 12 (10) ◽  
pp. 946-951 ◽  
Author(s):  
Federico Cagnazzo ◽  
Pierre-Henri Lefevre ◽  
Imad Derraz ◽  
Cyril Dargazanli ◽  
Gregory Gascou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Conservative Treatment ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Random Effects Models ◽  
Endovascular Recanalization ◽  
Cervical Internal Carotid Artery ◽  
Treatment Related Mortality ◽  
Related Mortality

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.

Abstract WP169: Endovascular Recanalization For The Total Occlusion Of The Internal Carotid Artery At Subacute To Chronic Stage: Clinical Outcome And Pitfalls

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tomoaki Terada
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Carotid Occlusion ◽  
Chronic Stage ◽  
Embolic Protection ◽  
Hemodynamic Compromise ◽  
Endovascular Recanalization ◽  
Internal Carotid Occlusion

Objective: The efficacy and pitfalls of endovascular recanalization for totally occluded internal carotid occlusion were evaluated. Materials and methods: Twenty-five cases (twenty six lesions) of symptomatic internal carotid occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. At the same period, total 1200 carotid artery stenting was performed in our group. Parodi’s embolic protection system or modified Parodi’s technique was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal internal carotid artery to the common carotid artery. Results: Recanalization of the occluded ICA was possible in 23/26 (88.5%) lesions. The occlusion points were cervical internal carotid artery : 19, and petrous - cavernous ICA : 4 in successfully recanalized cases. The patient’s ischemic symptom disappeared completely after the treatment and new ischemic symptoms did not appear related to the treated leision. Single photon emission computed tomography findings demonstrated the improvement of hemodynamic compromise in all cases with hemodynamic compromise. One case (4.3%) caused right middle cerebral artery branch occlusion during the procedure but his neurological symptoms were stable because of preexisting hemiparesis. One case (4.3%) demonstrated asymptomatic re-occlusion at the treated site. Discussion: Endovascular recanalization was possible and effective to improve hemodynamic compromise, although the incidence of this treatment is only 2.2% of the total 1200 carotid artery stenting in our series. However, there still several problems existed, such as hyperperfusion syndrome after recanalization, cerebral embolism during the treatment, and durability after treatment, and difficult identification of the occlusion point before the treatment. Conclusion: Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for the symptomatic internal carotid occlusion with hemodynamic compromise or refractory to antiplatelet therapy, even in the subacute to chronic stage of the illness.

Endovascular recanalization of symptomatic flow-limiting cervical carotid dissection in an isolated hemisphere

2011 ◽  
Vol 30 (6) ◽  
pp. E16 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Basar Atalay ◽  
Adel M. Malek
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Hemodynamic Compromise ◽  
Endovascular Recanalization

Object Internal carotid artery dissection (ICAD) is a common cause of stroke in young patients, which may lead to major transient or permanent disability. Internal carotid artery dissection may occur spontaneously or after trauma and may present with a rapid neurological deterioration or with hemodynamic compromise and a delayed and unstable neurological deficit. Endovascular intervention using stent angioplasty can be used as an alternative to anticoagulation and open surgical therapy in this setting to restore blood flow through the affected carotid artery. Methods The authors present the cases of 2 patients with flow-limiting symptomatic ICAD leading to near-complete occlusion and without sufficient collateral supply. Both patients had isolated cerebral hemispheres without significant blood flow from the anterior or posterior communicating arteries. In both cases, the patients demonstrated blood pressure–dependent subacute unstable neurological deficits as a result of the hemodynamic compromise resulting from the dissection. Results Both patients underwent careful microwire-based selection of the true lumen followed by confirmatory microinjection and subsequent exchange-length microwire-based recanalization using tandem telescoping endovascular stenting. In both cases the neurological state improved, and no permanent neurological deficit ensued. Conclusions The treatment of ICAD may be difficult in patients with subacute unstable neurological deficits related to symptomatic hypoperfusion, especially in the setting of a hemodynamically isolated hemisphere. Anticoagulation alone may be insufficient in these patients. Although there is no widely accepted guideline for the treatment of ICAD, the authors recommend stent-mediated endovascular recanalization in cases of symptomatic flow-limiting hemodynamic compromise, especially in cases of an isolated hemisphere lacking sufficient communicating artery compensatory perfusion.

scholarly journals Endovascular revascularization of symptomatic chronic total occlusions of the internal carotid artery using a proximal balloon protection device

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199887
Author(s):  
Guojie Zhai ◽  
Zhichao Huang ◽  
Huaping Du ◽  
Yuan Xu ◽  
Guodong Xiao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Protection Device ◽  
Period Range ◽  
Chronic Total Occlusions ◽  
Endovascular Recanalization ◽  
Endovascular Revascularization ◽  
Balloon Protection

To investigate the feasibility, efficacy, and safety of endovascular recanalization for symptomatic chronic internal carotid artery occlusions (ICAO). Thirty patients with symptomatic chronic ICAO were treated using the endovascular recanalization method. Proximal balloon protection devices were used to prevent embolic migration by completely blocking the blood flow. The morphology of the internal carotid artery (ICA) at the occluded segment based on catheter angiography was analyzed. Recanalization of symptomatic chronic internal carotid artery occlusion (CICAO) was successful in 20 of the 30 patients (66.7%). The time required for successful revascularization ranged from 120 to 180 min (mean, 150 min). Of the 20 successful patients, 14 were at the cervical ICAs, and six were at the intracranial ICAs. No permanent complications occurred in our study. Ischemic symptoms related to chronic ICAO did not occur during the 18.3 month follow-up period (range, 12–24 months) in the 20 successful patients. Endovascular revascularization can improve hemodynamic compromise. The treated sites of all 20 successfully recanalized patients were patent on computed tomographic angiography or carotid duplex sonography, and no case with >50% restenosis was observed during the follow-up period. Three patients with failed recanalization had a stroke during the follow-up period. Endovascular revascularization of symptomatic CICAO using a proximal balloon protection device is technically feasible in selected patients, and the outcomes are favorable for patients who benefit from revascularization.

Sign in / Sign up

Export Citation Format

Share Document