Chronic occlusion of the internal carotid artery: Endovascular revascularization technique of long occlusive lesions

2020 ◽  
Vol 47 (4) ◽  
pp. 318-322 ◽  
Author(s):  
Federico Cagnazzo ◽  
Cyril Dargazanli ◽  
Pierre-Henri Lefevre ◽  
Gregory Gascou ◽  
Imad Derraz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Chronic Occlusion ◽  
Endovascular Revascularization

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

2012 ◽  
Vol 18 (3) ◽  
pp. 288-296 ◽  
Author(s):  
K. Namba ◽  
M. Shojima ◽  
S. Nemoto
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Initial Step ◽  
Posterior Wall ◽  
True Lumen ◽  
Chronic Occlusion ◽  
Arterial Lumen ◽  
Endovascular Revascularization ◽  
Anterior Side

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.

Wire escalation in emergent revascularization procedures of internal carotid artery occlusions: the use of high tip stiffness microguidewires

2017 ◽  
Vol 9 (6) ◽  
pp. 547-552 ◽  
Author(s):  
José E Cohen ◽  
Ronen R Leker ◽  
John M Gomori ◽  
Eyal Itshayek
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Revascularization Procedure ◽  
Inclusion Criteria ◽  
Successful Performance ◽  
Endovascular Revascularization ◽  
Angiographic Evidence ◽  
Total Coronary Occlusions ◽  
Revascularization Procedures

ObjectiveWe examined the usefulness and safety of high tip stiffness cardiac microguidewires in the endovascular revascularization of selected cases of internal carotid artery (ICA) occlusion.MethodsFiles of patients with acute ischemic symptoms due to ICA occlusions managed from August 2010 to August 2016 by urgent endovascular revascularization were retrospectively reviewed with a waiver of informed consent. Cases where there was escalation to stiff tipped cardiovascular microguidewires after at least two failed attempts to cross the carotid occlusion with standard neuro-microguidewires were included. Radiological and interventional data were recorded.Results63 patients with acute carotid occlusions underwent emergent endovascular revascularization in the study period; 5/63 patients met the inclusion criteria. In 4/5 patients, there was no angiographic evidence of the remnant origin of the ICA; in 1/5 there was a wide round shaped proximal calcified cap that precluded soft guidewire entry. In all cases, antegrade wiring was achieved only after switching to stiffer guidewires designed for the management of chronic cardiac occlusions. The use of these stiffer tip wires was considered of critical importance in achieving the successful performance of the ICA revascularization procedure. In all patients, revascularization was achieved, and 90 day modified Rankin Scale score ranged from 0 to 2.ConclusionsWhen regular neuro-guidewires do not allow antegrade wiring in cases of ICA occlusion, wire escalation to high tip stiffness guidewires may improve success. These wires, designed to deal with chronic total coronary occlusions, can serve as a platform for new neuro-guidewires to be used in the challenging field of resistant supra-aortic occlusions.

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.

Abstract TP137: Characteristics of Perfusion Profiles in Patients With Chronic Internal Carotid Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jill Ting-Yu Chang ◽  
Soren Christensen ◽  
Michael Mlynash ◽  
Michael P Marks ◽  
Jeremy J Heit ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Ischemic Event ◽  
Chronic Occlusion ◽  
The Status ◽  
History Of ◽  
Cerebral Ischemic

Introduction: Internal carotid artery (ICA) occlusion may cause an acute stroke or may remain asymptomatic for years. Differences in the perfusion characteristics between patients with acute symptomatic ICA occlusions and those with chronic ICA occlusions have not been defined. The aim of this study is to identify the characteristics of the relatively “benign” perfusion pattern associated with chronic asymptomatic ICA occlusions and to determine if this pattern can be differentiated from the pattern observed in acutely symptomatic cases. Methods: We included 31 chronic ICA patients who had no history of a cerebral ischemic event for at least 1 year at the time of imaging and 20 patients with acute ischemic stroke caused by ICA occlusions from DEFUSE 2. All patients underwent MRI with perfusion. Perfusion parameters, including Tmax lesion volumes, hypoperfusion index (Tmax10/Tmax6), and CBV index (rCBV in Tmax6) were calculated by RAPID software. The status of the CBV, CBF, and MTT in the ischemic hemisphere was also rated by visual inspection on a 3-point scale (unchanged, reduced or increased). Differences were assessed by Mann-Whitney and Fisher’s exact tests. Results: The average age was 65.0±9.9 years in chronic vs. 64.7±14.2 years in acute ICA occlusion group ( p =0.90). Most of the chronic ICA patients had no territory with Tmax>10s (29/31) or Tmax>8s (24/31) in the ischemic hemisphere. The average Tmax lesion volumes were lower in the chronic ICA group (Tmax>6 of 14 ml and Tmax>4 of 81 ml) than in the acute ICA occlusion group (Tmax>6 of 131 ml and Tmax>4 of 220 ml, p <0.0001 for both, Figure). CBV was unchanged in all chronic occlusion cases. In the acute occlusion group, there were 12 out of 20 cases (60%) with decreased CBV ( p <0.0001). CBF was decreased in 1 (3%) patient with a chronic occlusion and 17 cases (85%) with acute occlusions ( p <0.0001). MTT prolonged in 7 cases (22%) with chronic occlusions vs. all cases (100%) with acute occlusions ( p <0.0001). Conclusions: Several features on perfusion MRI distinguish chronic ICA occlusions from acute occlusions. Patients with chronic ICA occlusions tend to have none or a minimal volume of tissue with Tmax>8s or >10s delay, smaller volumes of tissue with Tmax>4s and >6s delay, and normal appearing CBV and CBF maps.

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