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.

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

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 Technique to Expose the Posterior Wall Aneurysm of the Internal Carotid Artery by Its Rotation

1999 ◽  
Vol 27 (2) ◽  
pp. 134-138 ◽  
Author(s):  
Yuichiro TANAKA ◽  
Shigeaki KOBAYASHI ◽  
Kazuo KITAZAWA ◽  
Hiroyuki KAMIJO ◽  
Sumio KOBAYASHI
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Posterior Wall

scholarly journals Anterior Temporal Approach for the Treatment of the Posterior Wall Aneurysm of the Internal Carotid Artery.

2003 ◽  
Vol 31 (6) ◽  
pp. 431-435 ◽  
Author(s):  
Ken KAZUMATA ◽  
Hiroyasu KAMIYAMA ◽  
Tatsuya ISHIKAWA ◽  
Katsumi TAKIZAWA ◽  
Takahiro MAEDA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Posterior Wall

scholarly journals Ultrasound imaging of carotid web with atherosclerosis plaque: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Bin Ning ◽  
Dong Zhang ◽  
Binbin Sui ◽  
Wen He
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Internal Carotid ◽  
Posterior Wall ◽  
Left Internal Carotid Artery ◽  
Correct Treatment ◽  
Lateral Posterior ◽  
Missed Diagnosis

Abstract Background To the best of our knowledge, no previous studies on carotid webs with atherosclerosis plaque have been conducted. Thus, both radiologists and clinicians have insufficient knowledge of this disease, which could lead to misdiagnosis and missed diagnosis. An accurate diagnosis is beneficial to clinical management and prevention of stroke. Here, we present a case of a carotid web with an atherosclerotic plaque, which was confirmed by histopathology and was treated at the Department of Neurosurgery, Beijing Tiantan Hospital. Case presentation We report a rare case of a carotid web with an atherosclerotic plaque in a 61-year-old Han man. He presented to our hospital with history of intermittent dizziness and slurred speech for 1.5 years and numbness of both upper limbs for 4 months. A computed tomography angiography examination indicated severe stenosis at the beginning of the left internal carotid artery with plaque surface ulceration. Doppler ultrasound examination showed a carotid web with a thin isoechoic plaque and a membrane-like structure protruding into the lumen from the lateral posterior wall at the beginning of the left internal carotid artery. The thin isoechoic plaque could be seen at the base of the membrane-like structure. Carotid endarterectomy was performed to alleviate symptoms. A carotid web with atherosclerosis was diagnosed intraoperatively, and postoperative pathology confirmed extensive intima fibroid hyperplasia accompanied with myxoid degeneration. The base of the carotid web was attached to the thin atherosclerosis plaque, and between the web and the plaque, a cavity was observed. In this case report, we aim to discuss the diagnosis of carotid web with atherosclerosis, its physiopathology and management, and the possible reasons for missed diagnosis or misdiagnosis. Conclusion Carotid webs with atherosclerosis have no known etiological factors and are rarely reported. Thus, carotid webs could be easily confused with ulcerations on the surface of the atherosclerosis plaque. The diagnosis could be difficult and effective management remains indeterminate. Moreover, prompt recognition of this disease is key to correct treatment and management. Hence, this case report and the relevant data in the literature could contribute to the improvement of the diagnosis and treatment of this disease.

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.

scholarly journals Our experience in using of intravascular recanalization methods for treatment of acute ischemic stroke

2020 ◽  
Vol 32 (2) ◽  
pp. 67-78
Author(s):  
V.O. Pyatikop ◽  
Yu.O. Kotlyarevsky ◽  
Yu.G. Sergienko
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Interventional Treatment ◽  
Negative Consequences ◽  
Intraarterial Infusion ◽  
Arterial Lumen ◽  
Arterial Thrombolysis

Objective ‒ to evaluate results of the introduction of intravascular recanalization in the provision of emergency care to patients with ischemic stroke.Materials and methods. The experience of intraarterial thrombolysis on the example of 25 clinical cases was analysed. In 22 patients was performed selective intra-arterial thrombolysis, in 3 cases ‒ with thrombaspiration. All patients had a severe stroke, ranging from 15 to 25 points NIHSS. Confirmation of the diagnosis was performed according to computed tomography scan), ultrasound of the precerebral and cerebral arteries. Selective cerebral angiography was performed up to 6 hours after the onset of stroke. Patients were infused with 3 ml of recombinant tissue plasminogen activator bolus into the occluded vessel, followed by infusion at a dose of up to 20 ml for 1 hour, in 2 cases ‒ internal carotid artery stenting. Outcomes were assessed according to computed tomography, NIHSS and a modified Rankin scale for 30 days.Results. The combination of methods of intra-arterial thrombolysis and stenting of the internal carotid artery made it possible to minimized the negative consequences with sufficient restoration of the arterial lumen, which was controlled with digital subtraction angiography.Conclusions. Intravascular thrombectomy is the most promising and actively develo-ping area of ​​interventional treatment of ischemic stroke. Indication for selective intraarterial infusion of thrombolytics is the presence of acute cerebral circulatory disorders of the ischemic type in the middle cerebral artery pool when it is impossible to conduct mechanical thrombextraction.

Sign in / Sign up

Export Citation Format

Share Document