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Published on: March 11, 2018
Endovascular recanalization of chronically occluded internal carotid artery
Federico Cagnazzo1, Pierre-Henri Lefevre2, Imad Derraz2
1Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France f.cagnazzo86@gmail.com.
Insights
Endovascular treatment for symptomatic chronically occluded internal carotid artery (COICA) achieved a 72.6% recanalization rate with 5% permanent complications. Successful recanalization significantly reduced thromboembolism risk compared to medical management.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- The indication for endovascular treatment in symptomatic chronically occluded internal carotid artery (COICA) remains debated.
- Assessing outcomes of endovascular treatment for COICA is crucial for clinical decision-making.
Purpose of the Study:
- To systematically evaluate the outcomes of endovascular treatment in patients with symptomatic COICA.
- To identify factors influencing recanalization success and complication rates.
Main Methods:
- A systematic literature search was conducted across three databases following PRISMA guidelines.
- Data from 13 studies involving 528 patients undergoing endovascular treatment for COICA were analyzed.
- Random-effects models were used to analyze outcomes, including recanalization rates, complications, and mortality.
Main Results:
- Successful recanalization was achieved in 72.6% of patients.
- Overall complications occurred in 18%, with 5% permanent events and 9% thromboembolisms.
- Shorter occlusion duration (<1 month), younger age (<70 years), and cervical artery lesions were associated with better outcomes.
- Successful recanalization significantly reduced thromboembolism and mortality rates compared to conservative treatment.
Conclusions:
- Endovascular treatment offers a 70% successful recanalization rate for COICA with a 5% morbidity rate.
- Patient age, lesion location, and occlusion duration are key factors influencing treatment success and safety.
- Successful recanalization substantially lowers the risk of thromboembolic events, suggesting a benefit over medical management.
Background:
It is debated whether endovascular treatment is indicated for a symptomatic chronically occluded internal carotid artery (COICA).
Objective:
To assess outcomes after endovascular treatment of COICA.
Methods:
We performed a systematic search of three databases (PRISMA guidelines), including endovascular series of COICA. Outcomes were analyzed with random-effects models.
Results:
We included 13 studies and 528 endovascularly treated patients with COICA. Successful recanalization was 72.6% (347/528, 95% CI 65.4% to 79.9%, I2=68.9%). Complications were 18% (88/516, 95% CI 12.1% to 23.8%, I2=65%), with 5% (25/480, 95% CI 2% to 7%, I2=0%) of permanent events, and 9% (43/516, 95% CI 6% to 13%, I2=34%) of thromboembolisms. Treatment-related mortality was 2% (11/516, 95% CI 0.5% to 2.6%, I2=0%). Shorter duration of the occlusion was associated with higher recanalization: 80% (11/516, 95% CI 54% to 89%, I2=0%), 63% (33/52, 95% CI 49% to 76%, I2=0%), and 51% (18/35, 95% CI to 37% to 88%, I2=40%) recanalization rates for 1, 3, and >3 months occlusions, respectively. Complications were 6% (3/50, 95% CI 3% to 21%, I2=0%), 14% (4/27, 95% CI 5% to 26%, I2=0%), and 25% (13/47, 95% CI 10% to 30%, I2=0%) for 1, 3, and >3 months occlusions, respectively. Patient aged <70 years presented higher revascularization rates (OR=3.1, 95% CI 1.2 to 10, I2=0%, p=0.05). Successful reperfusion was higher (OR=5.7, 95% CI 1.2 to 26, I2=60%, p=0.02) and complications were lower (OR=0.2, 95% CI 0.6 to 0.8, I2=0%, p=0.03) for lesions limited to the cervical internal carotid artery compared with the petrocavernous segment. Successful recanalization significantly lowered the rate of thromboembolisms (OR=0.2, 95% CI 0.8 to 0.6, I2=0%, p=0.01) and mortality (OR=0.5, 95% CI 0.1 to 0.9, I2=0%, p=0.04), compared with conservative treatment.
Conclusions:
Endovascular treatment of COICA gives a 70% rate of successful recanalization, with 5% morbidity. Patients aged <70 years, lesions limited to the cervical internal carotid artery, and a shorter duration of the occlusion decreased the risk of complications. Successful recanalization of symptomatic lesions lowered by about 80% the likelihood of thromboembolisms, compared with medical management.
