Effect of occlusion site on endovascular recanalization of chronic internal carotid artery occlusion

Abstract

Objective To explore whether occlusion site affects success rate, methods of recanalization, perioperative complications, and prognosis of recanalization in chronic internal carotidartery occulsion (CICAO). Methods Thirty⁃nine patients diagnosed as CICAO from January 2017 to January 2020, and treated by endovascular recanalization were retrospectively reviewed. Baseline information, endovascular procedures, complications, clinical and angiographic prognosis were collected. Effects of occlusion site were analyzed. Results Thirty patients (76.92%) achieved successful endovascular recanalization. Successful recanalization rates varied among groups with different occlusion sites of extracranial short segment (C1, C1-C2 or C1-C3), medium segment (C1-C4), long segment (C1-C5 or C1-C6) and intracranial short segment (C6 or C6-C7) were 9/11, 8/10, 9/14 and 4/4, respectively. Sole angioplasty with balloon was applied in 7 patients (23.33%), sole stenting in 15 (50%), angioplasty with balloon and stents in 8 (26.67%). Among different occlusion sites of extracranial short, medium, long segment and intracranial short segment, soleangioplasty with balloon wasappliedin 0/9,1/8,3/9 and 3/4; while sole stenting was appliedin 9/9,4/8,1/9 and 1/4. Procedure⁃related complications were not related with occlusion site. One patient (33.33%) died, while 29 surviving patients during a median clinical follow⁃ up of 16 (4,27) months with successful recanalization, only one (3.45%) developed ipsilateral minor stroke due to restenosis. With a median angiographic follow⁃up of 5.50 (3.50, 8.00) months, 2 restenosis and 3 reocclusion were found in 21 patients, all of which came from medium and long segment occlusion. Conclusions Endovascular recanalization is feasible and effective in CICAO with relatively low procedure ⁃ related complications. However, success rate of recanalization decreases in groups of long segment occlusion. Application of angioplasty methods differs in groups with varying occlusion sites. Procedure⁃ related complications seem relatively low. While, restenosis and reocclusion are mostly found in long segment occlusion. DOI：10.3969/j.issn.1672⁃6731.2020.06.006

Keywords

• arterial occlusive diseases
• carotid artery, internal
• angioplasty
• intraoperative complications