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Published on: January 18, 2018
Endovascular recanalization for symptomatic chronic internal carotid artery occlusion: proposal of a modified
Chun Zhou1, Yue-Zhou Cao1, Sheng Liu1
1Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
Insights
A new angiographic classification for chronic internal carotid artery occlusion (CICAO) helps identify patients who will benefit from endovascular recanalization, improving outcomes.
Area of Science:
- Vascular Surgery
- Interventional Neuroradiology
- Medical Imaging
Background:
- Chronic internal carotid artery occlusion (CICAO) presents a significant challenge in stroke management.
- Accurate patient selection is crucial for successful endovascular recanalization outcomes.
Purpose of the Study:
- To develop and validate a novel angiographic classification system for CICAO.
- To correlate angiographic patterns with the success rates of endovascular recanalization.
Main Methods:
- Retrospective analysis of 51 patients with symptomatic CICAO undergoing endovascular recanalization.
- Stratification of angiographic images based on occlusive patterns and distal lumen reconstitution using digital subtraction angiography (DSA).
Main Results:
- A four-type classification (I-IV) was established, correlating with recanalization success rates (Type I: 90.3%, Type II: 60.0%, Type III: 50.0%, Type IV: 0%).
- Successful revascularization significantly improved modified Rankin Scale (mRS) scores.
- The overall intraoperative complication rate was 11.8% with no severe neurological damage or death.
Conclusions:
- The proposed angiographic classification is a comprehensive tool for selecting CICAO patients for endovascular treatment.
- This classification aids in predicting procedural difficulty and potential success rates.
Purpose:
To stratify angiographic images of chronic internal carotid artery occlusion (CICAO) into a newly modified angiographic classification, and identify suitable candidates for endovascular recanalization.
Methods:
This study included 51 consecutive patients with symptomatic CICAO who underwent endovascular recanalization at our institution. Patients' clinical information, angiographic findings, procedural results, and outcomes were recorded. We attempted to stratify all angiographic images into categories based on morphological occlusive patterns and distal internal carotid artery (ICA) lumen reconstitution on digital subtraction angiography (DSA).
Results:
Four types (I-IV) of CICAO were identified based on angiographic characteristics. We defined type I as having a tapered (IA) or blunt stump (IB) and distal ICA lumen reconstitution with collateral filling; type II as having no stump but with distal ICA lumen reconstitution; type III as having a tapered (IIIA) or blunt stump (IIIB) but no distal ICA lumen reconstitution; type IV as having no stump and no distal ICA lumen reconstitution. The rate of successful recanalization was 90.3 % for type I, 60.0 % for type II, 50.0 % for type III, 0 % for type IV, respectively (P = 0.002). The overall intraoperative complication rate was 11.8 %, and none of them led to severe neurological damage or death. The follow-up modified Rankin Scale (mRS) scores were significantly decreased in successfully revascularized patients, whilst there were no significant changes in the other failed patients.
Conclusion:
For symptomatic CICAO, our newly modified angiographic classification may be comprehensive and useful in selecting suitable patients for recanalization and grading the difficulty of the procedures.
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