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Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization
Chao Xiao1,2, Xiuen Chen1, Lizhi Lu3
1Department of Neurology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China.
Insights
Endovascular recanalization significantly improves cognitive and neurological function in chronic internal carotid artery occlusion (CICAO) patients. Computed tomography perfusion (CTP) effectively monitors hemodynamic changes and perfusion improvements post-procedure.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Chronic internal carotid artery occlusion (CICAO) presents significant challenges for neurological recovery.
- Current treatment strategies for CICAO often focus on medical management, with limited options for restoring blood flow.
- Assessing the impact of interventions on cerebral hemodynamics and function is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the feasibility and clinical efficacy of endovascular recanalization in patients with CICAO.
- To explore the utility of computed tomography perfusion (CTP) in assessing hemodynamic changes and treatment response.
- To compare functional outcomes between patients undergoing recanalization and those receiving medical treatment alone.
Main Methods:
- A non-randomized controlled study involving 41 patients with symptomatic CICAO.
- Patients received either endovascular recanalization (n=20) or active medical treatment (n=21).
- Cognitive and neurological functions were assessed using standardized scales (MoCA, NIHSS, mRS) at baseline and 90 days post-treatment. CTP was used to evaluate cerebral hemodynamics before and after recanalization.
Main Results:
- Endovascular recanalization achieved a 60% success rate (12/20) with a 15% perioperative complication rate and no major adverse events.
- The recanalization group demonstrated significantly greater improvements in cognitive and neurological function compared to the medication group at 90-day follow-up.
- Successful recanalization led to significant improvements in cerebral blood perfusion on the affected side, as evidenced by CTP.
Conclusions:
- Short-term successful endovascular recanalization effectively enhances cognitive and neurological functions in CICAO patients.
- CTP serves as a valuable tool for quantitatively evaluating cerebral hemodynamic changes and perfusion improvements post-recanalization.
- CTP provides a reliable method for postoperative monitoring and assessment of treatment efficacy in CICAO patients.
Objective:
This study aimed to investigate the feasibility and clinical efficacy of endovascular recanalization in patients with chronic internal carotid artery occlusion (CICAO) and explore the application value of computed tomography perfusion (CTP) in endovascular recanalization.
Methods:
This non-randomized controlled study included 41 patients with CICAO. All patients received active medical treatment. In this study, patients with successful endovascular recanalization and those who refused endovascular recanalization were included in the recanalization and medication groups, respectively. Before and 90 days after treatment, cognitive function was evaluated using the Montreal Cognitive Function Assessment, and neurological function was evaluated using the National Institutes of Health Stroke Scale and modified Rankin scale. For patients with successful endovascular recanalization, brain CTP imaging was performed to evaluate hemodynamic changes in patients with CICAO before and three days after treatment.
Results:
Overall, 41 symptomatic patients with CICAO were included, and 20 patients received endovascular recanalization therapy, with a success rate of 60% (12/20). The perioperative complication rate was 15% (3/20); there were no events such as hyperperfusion, distal embolism, vascular rupture, or cerebral hemorrhage, and no stroke-related or death-related events. Patients were divided into a medication group (n=21) and recanalization group (n=12). After 90 days of follow-up, patients in the recanalization group showed greater improvement in overall cognitive and neurological function. In addition, successful endovascular recanalization significantly improved cerebral blood perfusion on the occluded side of patients with CICAO.
Conclusion:
Successful recanalization can effectively improve the overall cognitive and neurological functions of patients in the short term. CTP can be used to quantitatively evaluate not only the cerebral hemodynamic changes after internal carotid artery occlusion but also the improvement of cerebral blood perfusion after successful endovascular recanalization, which provides a reliable method for postoperative follow-up.
