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Retrograde endovascular revascularization for chronic total occlusion of the internal carotid artery: a case report
Takeshi Uno1, Masaaki Shojima2, Yuta Oyama3
1Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan. unot-tky@umin.ac.jp.
Insights
This study presents a novel retrograde approach for endovascular revascularization of chronically occluded internal carotid arteries (ICAs). This technique successfully reopened the blocked artery, resolving transient ischemic attacks in the patient.
Area of Science:
- Neuroendovascular intervention
- Cerebrovascular disease management
- Interventional neuroradiology
Background:
- Endovascular revascularization of chronically occluded internal carotid arteries (ICAs) presents significant challenges due to lesion length and tortuosity.
- Traditional antegrade approaches may be less effective in complex ICA occlusions.
- Developing alternative strategies is crucial for improving treatment outcomes.
Observation:
- A case of successful recanalization of a chronically occluded ICA is described.
- The procedure utilized a retrograde guidewire passage from the intracranial ICA to the cervical ICA.
- The posterior communicating artery served as the access route for the retrograde maneuver.
Findings:
- The retrograde approach enabled successful recanalization of the chronically occluded internal carotid artery.
- This technique mirrors successful retrograde strategies employed in percutaneous coronary interventions.
- The patient experienced complete resolution of daily transient ischemic attacks post-procedure.
Implications:
- The retrograde approach offers a potentially valuable strategy for neurovascular interventions involving complex ICA occlusions.
- This method may expand treatment options for patients with previously untreatable carotid artery disease.
- Further investigation into the retrograde technique could enhance the safety and efficacy of endovascular stroke prevention.
Abstract:
Endovascular revascularization of a chronically occluded internal carotid artery (ICA) is challenging because the occlusive segment can be long and tortuous. A case is presented of a successful recanalization of a chronically occluded ICA by retrograde passing of a guidewire from the intracranial ICA to the cervical ICA via the posterior communicating artery. This case suggests that a retrograde approach for reopening an occluded artery may be useful during neurovascular interventions, similar to percutaneous coronary interventions. In this patient, daily transient ischemic attacks disappeared after successful recanalization of the ICA.
