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.

Urgent Cerebral Revascularization Bypass Surgery for Iatrogenic Skull Base Internal Carotid Artery Injury

2014 ◽  
Vol 10 (4) ◽  
pp. 640-648 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Cameron G. McDougall ◽  
Robert F. Spetzler ◽  
Peter Nakaji
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Cerebral Revascularization ◽  
Revascularization Procedure ◽  
Cavernous Sinus Meningioma ◽  
Posterior Communicating Artery Aneurysm ◽  
Internal Carotid Artery Injury

Abstract BACKGROUND: When feasible, the management of iatrogenic internal carotid artery (ICA) injury during skull base surgery is mainly endovascular. OBJECTIVE: To propose a cerebral revascularization procedure as a rescue option when endovascular treatment is not feasible. METHODS: We retrospectively reviewed all extracranial-intracranial (EC-IC) bypass procedures performed between July 2007 and January 2014. RESULTS: From 235 procedures, we identified 8 consecutive patients with iatrogenic ICA injury managed with an EC-IC bypass. Injury to the ICA occurred during an endoscopic transsphenoidal surgery (n = 3), endoscopic transfacial-transmaxillary surgery (n = 1), myringotomy (n = 1), cavernous sinus meningioma resection (n = 1), posterior communicating artery aneurysm clipping (n = 1), and cavernous ICA aneurysm coiling (n = 1). Endovascular management was considered first-line treatment but was not successful. All patients received a high-flow EC-IC bypass. At a mean clinical/radiographic follow-up of 19 months (range, 3-36 months), all patients had a modified Rankin Scale score of 0 or 1. All bypasses remained patent. CONCLUSION: Iatrogenic injury of the skull base ICA is uncommon but can lead to lethal consequences. Many injuries can be treated with endovascular techniques. However, certain cases may still require a cerebral revascularization procedure.

Spontaneous reversal of internal carotid artery occlusion

1981 ◽  
Vol 54 (6) ◽  
pp. 811-813 ◽  
Author(s):  
Joseph F. Cusick ◽  
David Daniels
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Total Occlusion ◽  
Content Type ◽  
Spontaneous Reversal ◽  
Angiographic Evidence ◽  
Spontaneous Dissection

✓ Spontaneous dissection of the internal carotid arteries, including those dissections resulting in total occlusion, may be a spontaneously reversible process. A patient who had angiographic evidence of bilateral complete internal carotid artery occlusions of different ages of onset illustrates this process. This case suggests certain considerations regarding the pathogenesis of these dissections.

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 Revacept, an Inhibitor of Platelet Adhesion in Symptomatic Carotid Artery Stenosis: Design and Rationale of a Randomized Phase II Clinical Trial

TH Open ◽  
2020 ◽  
Vol 04 (04) ◽  
pp. e393-e399
Author(s):  
Klaus Gröschel ◽  
Timo Uphaus ◽  
Ian Loftus ◽  
Holger Poppert ◽  
Hans Christoph Diener ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Phase Ii ◽  
Carotid Artery Stenosis ◽  
Platelet Adhesion ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
Revascularization Procedure ◽  
Symptomatic Carotid

AbstractPatients with stroke or transient ischemic attacks (TIAs) and internal carotid artery stenosis harbor an increased risk of recurrent stroke especially within 2 weeks after the first event. In addition, the revascularization procedure itself (carotid endarterectomy [CEA] or carotid artery stenting [CAS]) is associated with both clinically apparent and silent brain infarctions, mainly caused by the embolic nature of the ruptured carotid plaque. The glycoprotein VI (GPVI) fusion protein Revacept is a highly specific antithrombotic drug without direct inhibition of systemic platelet function that might reduce periprocedural distal embolization from the vulnerable ruptured plaque located at the internal carotid artery. By shielding collagen at the site of vascular injury, Revacept inhibits plaque-mediated platelet adhesion and aggregation, while not directly affecting systemic hemostasis. In this phase II study, 158 patients with symptomatic carotid artery stenosis with recent TIA or stroke were randomized to receive a single dose of either Revacept (40 or 120 mg) or placebo. All patients were on standard secondary preventive therapy (statins and platelet inhibition) and underwent CEA, CAS, or best medical therapy according to current guidelines. The efficacy of Revacept was evaluated by exploratory assessment of new diffusion-weighted imaging lesions on magnetic resonance imaging after the revascularization procedure; a combination of cardiovascular events (ischemic and hemorrhagic stroke, TIA, myocardial infarction, or coronary intervention) and bleeding complications served to assess clinically critical patients' outcome and safety. This exploratory phase II randomized, double-blind clinical trial provides valuable insights on the safety, tolerability, and efficacy of Revacept in patients with symptomatic carotid artery stenosis.

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.

Revascularization procedures in internal carotid artery pseudo-occlusion

2004 ◽  
Vol 146 (3) ◽  
pp. 237-243 ◽  
Author(s):  
C. Greiner ◽  
H. Wassmann ◽  
S. Palkovic ◽  
C. Gauss
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Revascularization Procedures

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 P518: Intravascular Ultrasound Assisted Endovascular Revascularization in Patients With Subacute and Chronic Internal Carotid Artery Occlusions

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nitish F Kumar ◽  
Vamshi Balasetti ◽  
Kimberly Pfeiffer ◽  
Brandi R French ◽  
Camilo R Gomez ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intravascular Ultrasound ◽  
Internal Carotid ◽  
Imaging System ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Revascularization Procedure ◽  
Carotid Revascularization

Background: Revascularization of subacute or chronic internal carotid artery occlusion is technically feasible in some patients but carotid revascularization procedure needs to be optimized to improve the clinical success of the procedure. Objective: To describe our experience using intravascular ultrasound (IVUS) as adjunct to carotid revascularization procedure in patients with subacute or chronic internal carotid artery occlusion. Materials and Methods: Endovascular recanalization was attempted in 7 patients with symptomatic internal carotid artery occlusions between 3 and 11 days of symptoms onset. Distal protection device was deployed in all the patients followed by advancement of IVUS catheter (Eagle Eye Gold, 20 MHZ Digital, s5 Imaging System, Volcano Corp.) to obtain gray-scale and virtual histology (VH) images at regions of interest. IVUS images used to categorize occlusion content as: dark green- fibrous; yellow/green- fibrofatty; white- calcified; red- necrotic lipid core plaque on images. Intravascular thrombus was diagnosed an echolucent, homogeneous, well-delineated, diaphragm-like intraluminal structure. Results: The occlusion was recanalized successfully in all of 7 patients with median age 67.4±7.5 years. IVUS demonstrated intravascular thrombus in 5 of 7 patients. Fibrous and fibrofatty constituents of plaque were seen in 5 of the 7 patients in whom VH was done. Calcification and lipid necrotic core each were seen in 3 of 5 patients.5 patients with large thrombus burden on IVUS were treated using aspiration thrombectomy. Six of seven patients underwent stent placement and one patient underwent primary angioplasty. 5 of 7 patients had modified Rankin Scale of 0-2 at follow up (3 weeks to 4 months post procedure). Conclusions: IVUS provided valuable information to optimize carotid revascularization procedure in patients with subacute or chronic internal carotid artery occlusion.

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