Internal Carotid Artery Occlusion: Management

Saini, Harneel; Cerejo, Russell; Williamson, Richard; Malhotra, Konark

doi:10.1007/s11910-022-01201-x

Cited by 13 publications

(7 citation statements)

References 26 publications

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“…Revascularization techniques are mainly intracranial and extracranial vascular bypass surgery (such as superficial temporal artery-middle cerebral artery bypass surgery). Studies have shown that it can reduce the incidences of postoperative stroke recurrence and mortality, but there are not enough RCT studies to prove that revascularization therapy is better than medication alone [23]. It is generally believed that bypass surgery is recommended to reconstruct cerebral blood flow in patients with hemodynamic disturbance or recurrent stroke for whom drug therapy is ineffective, but the effect is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis

Tan,

Wang,

Xing

et al. 2023

Cerebrovasc Dis

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Introduction: Chronic internal carotid artery occlusion (CICAO) is a common cause of stroke and ischemia recurrence. An increasing number of reports have highlighted the potential of hybrid surgery for treating CICAO. There are few studies, specifically nonrandomized controlled trials, on the safety and effectiveness of hybrid surgery for the treatment of CICAO, so in this study, we hypothesized that hybrid surgery would be safe, have an acceptable complication rate and a high success rate. Methods: MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies published up to January 30, 2023. The primary endpoint was recanalization rates of occluded vessels, and the secondary endpoint was perioperative death and procedure-related complications. Subgroup analysis focused on the recanalization rates of endovascular intervention (EI) and hybrid surgery, as well as the rates of recanalization below the clinoid segment and at the clinoid segment and beyond. The follow-up visit was conducted at least 3 months after surgery, and stenosis or occlusion recurrence was confirmed by review of CTA or DSA scan. Results: The databases were searched and 1,709 records were identified, of which 16 articles were used in the meta-analysis, and 464 CICAO patients with complete data who underwent hybrid surgery were enrolled. Hybrid surgery was associated with higher success rates (RD = 0.87, 95% CI [0.84–0.91], p < 0.00001) than EI (OR = 4.71, 95% CI [2.32–9.56], p < 0.0001). The procedural success rate in the below-clinoid segment group was significantly higher than that in the clinoid segment and beyond group (OR = 13.76, 95% CI [5.31–35.66], p < 0.00001). The total periprocedural complication rate was low (RD = 0.11, 95% CI [0.07–0.15], p < 0.00001 and RD = 0.04, 95% CI [0.00–0.07], p = 0.03). Target vessel restenosis or reocclusion occurred in 35 patients (8%) during the follow-up period (RD = 0.08, 95% CI [0.04–0.12], p < 0.0001). Conclusion: Hybrid surgery is the combination of the advantages of open surgery and EI, has a high success rate and a low risk of recurrence of stenosis and occlusion in the long term. Randomized controlled trials on hybrid surgery for internal carotid artery occlusion are necessary.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis

Tan,

Wang,

Xing

et al. 2023

Cerebrovasc Dis

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“… 2 Around 70% of CICAO cases are due to atherosclerosis, and the embolism caused by the thrombi from the occlusion stump or the atherosclerotic plaques is one of the common mechanisms for subsequent ischemic stroke. 3 Elevated inflammatory markers correlate with poor prognosis in this population with large-vessel atherothrombotic cerebral infarction. 4 …”

Section: Introductionmentioning

confidence: 98%

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients with Chronic Internal Carotid Artery Occlusion Complicated by Cerebral Infarction

Zhuo-yin¹,

Guo²,

Sheng³

et al. 2022

NDT

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Purpose This study aims to investigate the prognostic value of the peripheral neutrophil-to-lymphocyte ratio (NLR) in patients with chronic internal carotid artery occlusion (CICAO) complicated by cerebral infarction. Patients and Methods The clinical data of 99 CICAO patients complicated by cerebral infarction were retrospectively analyzed. The modified Rankin Scale (mRS) was used to assess their 3-month prognosis, and a multivariate logistic regression model was established to explore risk factors for poor prognosis. Results Multivariate logistic regression analysis demonstrated that NLR (OR=2.114; 95% CI: 1.129–3.959) and baseline National Institute of Health Stroke Scale (NIHSS; OR=1.288, 95% CI: 1.053–1.574) score were risk factors of poor prognosis. The area under the receiver operator characteristic (ROC) curve of NLR in predicting the 3-month outcome after onset was 0.717 (95% CI: 0.606–0.828, P <0.000). The optimal cut-off value was 3.22, with a sensitivity of 0.743 and a specificity of 0.791. Conclusion NLR is an independent risk factor for the poor prognosis of CICAO patients complicated by cerebral infarction and can serve as an indicator for clinical prognosis.

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“…Non-acute occlusion of internal carotid artery (ICA) is usually caused by chronic development of atherosclerosis 1 – 6 , and chronic atherosclerotic occlusion of large intracranial arteries, including the ICA 5 , 7 , 8 , is one of the critical causes for ischemic cerebral stroke, accounting for approximately 15,000–20,000 ischemic events in the United States of America 9 , 10 . In the chronic process of stenosis progression, collateral arterial branches are often formed, and adjacent small vessels may also compensate, which improves the cerebral tissue perfusion.…”

Section: Introductionmentioning

confidence: 99%

“…Bypass surgery may not reduce the ipsilateral recurrent stroke rate two years later 16 . Endovascular recanalization and hybrid surgery comprising endovascular approaches and carotid endarterectomy (CEA) have been applied for the treatment of non-acute ICA occlusion, leading to good effects 1 – 6 , 17 – 21 . For long-segment ICA occlusion involving the initial ICA C1 segment 22 , CEA is good to eliminate the carotid plaques before endovascular treatment for intracranial lesions.…”

Section: Introductionmentioning

confidence: 99%

Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery

Zhao,

Xu,

Xue

et al. 2024

Sci Rep

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To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6–48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.

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Internal Carotid Artery Occlusion: Management

Cited by 13 publications

References 26 publications

Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis

Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients with Chronic Internal Carotid Artery Occlusion Complicated by Cerebral Infarction

Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery

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