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Published on: January 18, 2018
Endovascular Recanalization of Symptomatic Chronic ICA Occlusion: Procedural Outcomes and Radiologic Predictors
1From the Departments of Interventional Radiology (C.Z., Y.-Z.C., Z.-Y.J., L.-B.Z., H.-B.S., S.L.).
Insights
Endovascular recanalization is a safe and effective treatment for symptomatic chronic internal carotid artery (ICA) occlusion in select patients. Predictors of success include a tapered stump, distal occlusion segment, and shorter occlusion duration.
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.
Background And Purpose:
Endovascular recanalization has been attempted in patients with symptomatic chronic ICA occlusion, however, the heterogeneity of recanalization outcomes and the perioperative complications present challenges for the clinical application. Our aim was to evaluate the safety and efficacy of endovascular recanalization for symptomatic chronic ICA occlusion and identify potential predictors for successful recanalization.
Materials And Methods:
This study included 47 consecutive patients with symptomatic chronic ICA occlusion who underwent endovascular recanalization at our institution. Patients' clinical information, radiologic characteristics, procedural results, and outcomes were recorded. Factors related to technical success were analyzed by univariate and multivariate analyses.
Results:
The technical success rate was 74.5% (35/47); 12.8% of patients (6/47) experienced intraoperative complications, but none had permanent neurologic deficits. Three months after recanalization, 21 of the 29 recanalized patients (72.4%) and 3 of the 10 failed patients (30.0%) demonstrated improved mRS scores. Restenosis or re-occlusion occurred in 12.9% of patients (4/31) with successful recanalization. Multivariate analysis showed that tapered or blunt stump (P = .016), distal ICA occlusion segment (below the cavernous segment versus at or above the ophthalmic segment, P = .003; at the cavernous or clinoid segment versus at or above the ophthalmic segment, P = .027), and radiologic occlusion to recanalization of ≤3 months (P = .044) were significantly associated with successful recanalization. Patients were assigned points according to the coefficients of the prediction model, and the technical success rates were 0%, 46.2%, 90.5%, and 100% in patients with 1, 2, 3, and 4 points, respectively.
Conclusions:
Endovascular recanalization is a safe and effective treatment for symptomatic chronic ICA occlusion in selected patients. A residual stump, low levels of the distal ICA occlusion segment, and a short radiologic occlusion time were identified as positive predictors of technical success.
