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.
Common carotid occlusion for giant aneurysm of the cavernous internal carotid artery - An old but still effective operation.
