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Revascularization procedures in internal carotid artery pseudo-occlusion
C Greiner1, H Wassmann, S Palkovic
1Department of Neurosurgery, University of Muenster, Albert-Schweitzer-Strasse 33, 48148 Muenster, Germany.
Acta Neurochirurgica
|March 12, 2004
Summary
Surgical revascularization of internal carotid artery (ICA) pseudo-occlusion is feasible in most cases, even with reduced cerebrovascular reactivity (CVR). Angiography is key to identifying pseudo-occlusion for successful extracranial reopening.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Surgical treatment for internal carotid artery (ICA) pseudo-occlusion with reduced cerebrovascular reactivity (CVR) presents diagnostic and therapeutic uncertainties.
- Optimal timing and performance of revascularization remain debated.
Observation:
- A study evaluated 53 patients with symptomatic ICA stenosis diagnosed with extracranial ICA pseudo-occlusion via repeated Digital Subtraction Angiography (DSA).
- Angiographic findings included "string-like" anterograde filling or retrograde filling of the proximal ICA.
- All patients had reduced CVR and underwent extracranial carotid artery surgery.
Findings:
- Successful revascularization of the ICA was achieved in 75.5% of patients.
- ICA pseudo-occlusion was atheromatous, sometimes with floating thrombus, treated with thrombectomy.
- Peri-operative mortality was 1.9% and morbidity was 7.5%.
- 95% of reopened ICAs remained patent after a mean 4-year follow-up.
Implications:
- Selective DSA with late imaging is crucial for detecting ICA pseudo-occlusion in suspected cases.
- Extracranial ICA reopening is possible even with compromised CVR if specific angiographic signs are present.
- This supports surgical intervention for selected patients with ICA pseudo-occlusion.