Internal Carotid Artery Occlusion

Morris‐Stiff, Gareth; Teli, Mary; Khan, Pervez; Ogunbiyi, Samuel; Champ, Carrie; Hibberd, R.D.; Brown, Robert D.; Bailey, Damian Miles; Winter, R.; Lewis, M. H.

doi:10.1177/1538574413500539

Cited by 31 publications

(14 citation statements)

References 29 publications

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“…iv) In rare cases, a small but marked proportion of CTO of ICA may recanalize over time, even after more than 3 months of blockage ( 17 ). In a study by Morris-Stiff et al ( 18 ), the rate of recanalization was approximately 10%, and in previous studies, the rate was 2.3% ( 18 – 21 ). This spontaneous recanalization may increase blood flow to the diseased side of the brain, though may also lead to an increased risk of stroke ( 22 ).…”

Section: Natural History Of the Disordermentioning

confidence: 84%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

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At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction. The majority of cases of CTO of the ICA require treatment. In early studies, the results of external-ICA bypass were unsatisfactory, while recanalization is now considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Endovascular interventional recanalization, carotid endarterectomy (CEA) and hybrid surgery may be conducted in a select group of patients. As novel materials are developed, the success rate of simple recanalization may gradually increase; however, hybrid surgery may be more representative of the current trend, as advanced CEA can remove carotid atherosclerosis plaques, thus reducing the technological demands of the subsequent interventional recanalization. There are many complications that may result from recanalization following CTO of the ICA, including hyperperfusion and technical errors; therefore, the operation must be conducted carefully. If the recanalization is successful, it typically results in a stable improvement of patient condition in the long term. However, despite these conclusions, more studies are required in the future to further improve current understanding of CTO of the ICA.

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Section: Natural History Of the Disordermentioning

confidence: 84%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

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“…[14] Morris-Stiff et al followed up 153 patients with carotid artery occlusion using ultrasound, and found that 10.3% of the patients had spontaneous recanalization of the carotid artery occlusion and up to 23% of the patients experienced stroke in the ipsilateral occluded area. [4] These conclusions were inconsistent with the study by Gomensoro et al, which states that the disease is stable and no embolism would be observed after the ICA occlusion. [15] The mechanisms underlying a carotid artery occlusion-induced stroke may be as follows: first, hypodynamic cerebral infarction is caused by insufficient blood perfusion at the distal end of the occluded carotid artery.…”

Section: Discussionmentioning

confidence: 80%

“…[1,2] Previous studies have shown that the annual incidence rate of stroke is less than 3% to 5% in patients with carotid artery occlusion on drug treatments, but the stroke recurrence rate is as high as 20% in patients with poor collateral circulation. [3,4] Some patients may develop recurrent cerebral embolism in the occluded internal carotid artery (ICA), namely carotid stump syndrome (CSS). [5] CSS is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain.…”

Section: Introductionmentioning

confidence: 99%

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Xu¹,

Wang

Luo³

2019

Medicine

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Rationale:Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump.Patient concerns:A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted to evaluate collateral circulation, intraluminal composition, and shape of the carotid stump.Diagnoses:The patient was diagnosed with cerebral infarction and right carotid stump syndrome.Intervention:The patient underwent interventional recanalization of the occluded internal carotid artery, which relieved his symptoms and led to satisfactory therapeutic outcomes during the clinical follow-up.Outcomes:A 9-month clinical follow-up revealed no stroke recurrence.Lessons:Interventional recanalization for the carotid artery stump syndrome is feasible. Accurate preoperative evaluation including collateral circulation, intraluminal composition, and shape of the carotid stump can assure a successful vascularization and guided management.

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“…Gomensoro et al postulated that after complete thrombosis of the artery there is no possibility for emboli to pass into distal circulation [3]. However, later on several more theories were presented that explained the frequent neurologic symptomatology in patients with an occluded ICA, such as distal thrombus propagation into the cerebral arteries, embolization from occluded carotid stumps and even embolization from contralateral carotid arteries through collateral circulation [4, 16, 20]. In a recent paper, the natural history of ICA occlusion was analyzed in 153 patients diagnosed by CDS [20].…”

Section: Discussionmentioning

confidence: 99%

“…However, later on several more theories were presented that explained the frequent neurologic symptomatology in patients with an occluded ICA, such as distal thrombus propagation into the cerebral arteries, embolization from occluded carotid stumps and even embolization from contralateral carotid arteries through collateral circulation [4, 16, 20]. In a recent paper, the natural history of ICA occlusion was analyzed in 153 patients diagnosed by CDS [20]. After the mean follow-up period of 35 months (IQR 14–61 months), 29% of the patients had TIA or stroke and 25% in the territory of the occluded ICA.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

Babić

Tanasković

Nešković

et al. 2019

Surgery Research and Practice

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Purpose To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

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Internal Carotid Artery Occlusion

Abstract: Recanalization of ICA occlusion is common and leads to significant neurological events. Duplex ultrasound follow-up appears mandatory.

Cited by 31 publications

References 29 publications

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

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