Endovascular Recanalization of Symptomatic Chronic ICA Occlusion: Procedural Outcomes and Radiologic Predictors

Area of Science:

• Interventional Neurology
• Vascular Surgery
• Neuroimaging

Background:

• Symptomatic chronic internal carotid artery (ICA) occlusion presents challenges due to variable recanalization outcomes and complications.
• Endovascular recanalization is an emerging treatment option for these patients.
• Assessing safety, efficacy, and predictors of success is crucial for clinical application.

Purpose of the Study:

• To evaluate the safety and efficacy of endovascular recanalization for symptomatic chronic ICA occlusion.
• To identify predictors associated with successful recanalization.
• To stratify patients based on predicted technical success.

Main Methods:

• Retrospective analysis of 47 consecutive patients with symptomatic chronic ICA occlusion undergoing endovascular recanalization.
• Recording and analysis of clinical, radiologic, procedural, and outcome data.
• Univariate and multivariate analyses to identify factors predicting technical success.

Main Results:

• Technical success rate was 74.5% (35/47), with 12.8% experiencing intraoperative complications but no permanent deficits.
• Improved modified Rankin Scale (mRS) scores were observed in 72.4% of successfully recanalized patients and 30.0% of failed cases.
• Positive predictors for successful recanalization included a tapered/blunt stump, distal occlusion segment (below cavernous), and short occlusion-to-recanalization time (≤3 months).

Conclusions:

• Endovascular recanalization is a safe and effective treatment for carefully selected patients with symptomatic chronic ICA occlusion.
• A residual stump, lower distal ICA occlusion segment, and shorter occlusion duration are significant positive predictors of technical success.
• A predictive model based on these factors demonstrated varying success rates from 0% to 100% based on assigned points.