Percutaneous angioplasty of a chronic total occlusion of the intracranial internal carotid artery. Case report

Protected Endovascular Revascularization of Subacute and Chronic Total Occlusion of the Internal Carotid Artery

“…Symptomatic ischemic events did not occur in our patients and in the cases described in the previous case reports 10,11,14,15 ; however, 2 symptomatic ischemic events in 54 procedures (4%) were documented by Lin et al 16 There are no available data as to the asymptomatic ischemic lesion related to endovascular recanalization of the occluded ICA beyond the acute phase. In our study, 75% of patients did develop small asymptomatic ischemic lesions (4.9 per patient), as demonstrated by DWI.…”

“…However, since initial re- ports from Terada et al, 10 in which a patient underwent successful endovascular recanalization of a chronic ICA occlusion with proximal protection, several other successful reports have followed [11][12][13][14][15] ; for example, Kao et al 13 were successful in recanalizing 22 short-length (mean, 27.9 mm) chronic ICA occlusions among 30 cases (73%).…”

“…Although proximal protection alone can reduce the risk of thromboembolic complications, 10,15 insufficient reverse flow through long lesions can mitigate this effect by preventing elimination of debris. Thus, the present study used distal protection in combination with proximal protection to minimize the risk of thromboembolic complications.…”

“…17,18 Nonischemic adverse events can also develop after the procedure. Komiyama et al 15 reported a mild blue toe syndrome that developed 1 month after the endovascular recanalization of the occluded ICA, and Lin et al 16 described 1 pseudoaneurysm, 1 iatrogenic carotid cavernous fistula, and 1 cervical extravasation after their 54 endovascular procedures for chronic total occlusion of ICA. In the present study, minor complications (groin hematoma and retinal hemorrhage) occurred in 2 of 8 patients.…”

Carotid Intervention in Acute Stroke

“…41 The feasibility and safety of the endovascular recanalization of symptomatic chronic cervical ICA occlusion has been demonstrated recently. [42][43][44][45][46][47] In the series reported by Lin et al, 45 successful recanalization was achieved in 65% of the cases. The cumulative stroke/death rate was 4%, including 1 fatal nonipsilateral stroke after hospital discharge and 1 in-hospital minor ipsilateral stroke because of systemic hypotension.…”