Prognosis of patients with late spontaneous recanalization of the atherosclerotic occlusion of internal carotid arteries: A pilot case series

Abstract

Late spontaneous recanalization (SR) of an occluded internal carotid artery (ICA) has been rarely reported and the prognosis of affected patients remains elusive. In the present study, the incidence of late SR of atherosclerotic occlusion of the ICA and associated outcomes were assessed in a single center. A total of 36 patients with ICA occlusion, who underwent carotid artery stenting or vertebral artery stenting in arteries other than the occluded ICA, were prospectively included and followed up for ≥18 months. SR was diagnosed by color Doppler ultrasound imaging. The incidence of late SR, the functional outcome and the incidence of adverse cardiovascular events in these patients were evaluated. During the follow-up, three patients had late SR of the occluded ICA (8.3%). All patients had vascular events prior to the confirmation of late SR of the ICA. Subsequent to SR, the patients were clinically stable with preserved functional ability, based on the Modified Rankin Scale. Of these patients, one suffered from re-occlusion of the recanalized ICA without presenting with any novel significant symptoms. In conclusion, patients with late SR of the ICA appear to have preserved functional ability and favorable clinical outcomes. Large-scale cohorts are required to determine the clinical characteristics that contribute to the incidence of late SR of the ICA.

Delayed Recanalization—How Late Is Not Too Late?

“…She had new symptoms 1 month later and was successfully treated with recanalization by stenting and angioplasty. At the 9-month follow-up, she did not have any neurological symptoms [52]. Stenting and angioplasty may be a therapeutic option in select patients with chronic total carotid occlusion.…”

“…Patients with late SR of the ICA tended to have preserved neurological function and favorable clinical outcomes. Large-scale studies are needed, as this study was too small to perform reliable statistical analysis [52]. Shojima et al reported that 7 out of 8 patients with ICA occlusion for an average time of 19.4 ± 7.3 months were successfully recanalized, resulting in improved ipsilateral cerebral hemodynamics without symptomatic stroke.…”

Delayed revascularization in acute ischemic stroke patients

“…Patients with late SR of the ICA appear to have preserved functional ability and favorable clinical outcomes. 18 months follow-up mRS score was 2 ( Wu et al, 2018 ). In a case of study by Terada et al (2005) , a 73 old male with ICA occlusion presenting after 79 days post clinical symptoms appeared.…”

“…Rare cases of late spontaneous revascularization of internal carotid artery (ICA) have been reported. Wu et al (2018) reported the late spontaneous revascularization (SR) of ICA occlusion in 36 patients. The follow-up of the patients was done for more than 18 months.…”