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Published on: May 31, 2024
First experience with endovascular recanalization of chronic internal carotid artery occlusion
A E Petrov1, N Yu Tukanov1, V V Bobinov1
1Polenov Russian Scientific Research Institute of Neurosurgery - Branch of FSBI 'Almazov National Medical Research Centre' of the Ministry of Health Care of Russian Federation, 191014, Saint-Petersburg, Russian Federation.
Insights
Endovascular recanalization successfully restored internal carotid artery (ICA) lumen in 66.6% of patients with chronic occlusion, significantly reducing risks of recurrent ischemic events. This promising method offers effective restoration of brain perfusion.
Area of Science:
- Vascular Neurosurgery
- Endovascular Therapy
- Cerebrovascular Disease
Background:
- Atherosclerotic lesions affect 20-50% of the population, with chronic internal carotid artery (ICA) occlusion posing a significant stroke risk.
- Ischemic stroke develops in 6-15% of patients with chronic ICA occlusion, and annual risks of acute ischemic disorders range from 6-20% despite treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular recanalization for chronic internal carotid artery (ICA) occlusion.
Main Methods:
- Analysis of intravascular treatment outcomes in 12 patients (average age 57) with chronic ICA occlusion.
- Classification of occlusion types using the D. Hasan scale (2018).
- Assessment of technical success, restenosis, and recurrent ischemic events through imaging and follow-up.
Main Results:
- Successful ICA lumen restoration achieved in 8 (66.6%) out of 12 patients.
- No restenosis or recurrent ischemic events observed in 6 patients with successful recanalization.
- Technical success was not achieved in 4 patients, primarily those with Type D occlusions or severe scarring.
Conclusions:
- Endovascular recanalization is a promising and effective method for restoring chronic ICA occlusion.
- The procedure can normalize brain perfusion and reduce the risk of recurrent ischemic cerebral events.
- Challenges remain for specific occlusion types (e.g., Type D) and severely scarred arteries.
Background:
According to WHO, the number of people suffering from atherosclerotic lesions of the brachiocephalic arteries in different age groups is 20-50%. The development of ischemic stroke with existing chronic occlusion of the internal carotid artery (ICA) occurs with a frequency of 6-15%, and the annual risk of developing acute ischemic disorders in the ipsilateral basin, despite adequate drug treatment, ranges from 6 to 20%. The aim is to evaluate the efficacy and safety of endovascular recanalization in chronic ICA occlusion.
Material And Methods:
The analysis of the first results of intravascular treatment of 12 patients with chronic ICA occlusion on the basis of the vascular neurosurgical department of the Russian Research Neurosurgical Institute named after Professor A.L. Polenov. The age range is from 42 to 75 years (the average age is 57 years). There were 11 men (91.6%) and 1 woman (8.4%). Depending on the type of chronic occlusion, according to the D. Hasan scale (2018), the distribution of patients was as follows: type A (the presence of a proximal ICA stump of the 'candle' type + retrograde filling of the ICA to the stony/cavernous segments) - 4 patients; type B (the presence of a blindly ending proximal ICA stump without the formation of a 'candle' + retrograde filling of the ICA to the rocky/cavernous segments) - 3 patients; type C (occlusion of the ICA from the mouth + retrograde filling of the ICA to the rocky/cavernous segments) - 2 patients; type D (occlusion of the ICA from the mouth with the absence of retrograde filling of the stony/cavernous segments of the ICA) - 3 patients.
Results:
In 8 (66.6%) of the 12 patients, the ICA lumen was completely restored. According to the D. Hasan scale, type A was noted in 4 patients, type B in 3 patients, and type C in 1 patient. In 4 (33.3%) patients, technical success was not achieved, of which according to the D. Hasan scale: type D was observed in 3 patients, type C in 1 patient. Of the 8 patients with successful ICA recanalization, all underwent remote monitoring by computed tomographic angiography or digital subtraction angiography. No data confirming restenosis were obtained in 6 patients. There were no episodes of recurrent ischemic disorders. In 1 patient, thrombosis of stented ICA was detected against the background of the patient's self-withdrawal of double disaggregant therapy. Unsuccessful recanalization (4 patients), in our opinion, is associated with convolution of the ICA and severe scarring in the lumen of the occluded artery.
Conclusion:
Intravascular recanalization of chronic ICA occlusion is a promising method that can be effectively used to restore the full-fledged lost artery lumen and normalize brain perfusion to reduce the risks of recurrent ischemic cerebral events.
