Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment

Wu, Junnan; Fang, Chaoyou; Wei, Lingying; Liu, Yibo; Xu, Houshi; Wang, Xiaoyu; Yuan, Ling; Wu, Xuezhong; Xu, Yuanzhi; Zhang, Anke

doi:10.3389/fsurg.2022.971066

Front. Surg.

2022

DOI: 10.3389/fsurg.2022.971066

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Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment

Junnan Wu

Chaoyou Fang²,

Lingying Wei³

et al.

Abstract: Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a devastating stroke or die. It is important to note that CICAO causes cerebrovascular accidents. Currently, the external carotid-internal carotid (EC-IC) bypass technique is used to treat CICAO. However, many clinical studies showed that EC-IC bypass was not beneficial for many patients with CICAO. Meanwhile, endovascular intervention treatment options f… Show more

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Cited by 3 publications

References 104 publications

(164 reference statements)

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Comparison of the treatment strategies for symptomatic chronic internal carotid artery occlusion

Mei,

Zhang,

Jiang

et al. 2024

Journal of Vascular Surgery

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Comparison of the treatment strategies for symptomatic chronic internal carotid artery occlusion

Mei,

Zhang,

Jiang

et al. 2024

Journal of Vascular Surgery

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Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

Ren,

Xue,

Zhao

et al. 2023

Sci Rep

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To investigate the effect of endovascular and/or hybrid surgical recanalization on chronic long-segment occlusion of the internal carotid artery (ICA) and the effect of occlusion location on the recanalization rate and prognosis, 87 patients with chronic ICA occlusion treated with endovascular approach only or hybrid surgery were retrospectively enrolled. The duration of ICA occlusion ranged from 21 to 360 days (median 30). Type I occlusion (from the neck to below the cavernous segment) consisted of 46 (52.8%) patients while type II (from the neck to above the clinoid segment) of 41 (47.1%). Hybrid surgery was performed in 44 (50.6%) patients while endovascular recanalization only was conducted in the other 43 (49.4%). In all patients, the success rate of recanalization was 93.0% (40/43) for the endovascular approach and 95.5% for the hybrid surgical approach. In patients with type I occlusion, endovascular recanalization only was performed in 22 (47.8%) patients and hybrid surgery in 24 (52.2%), resulting in successful recanalization in all patients (100%). In patients with type II occlusion, the success rate of recanalization was 85.7% (18/21) for the endovascular approach only but 90% (18/20) for the hybrid surgery. The total success rate of recanalization was 94.3% (82/87) for all patients, 100% for type I occlusion, and 87.8% for type II occlusion. No significant (P = 0.12) differences existed in the recanalization rate between groups I and II. Clinical follow-up was performed in 82 (94.3%) patients 6–39 months (mean 16) after the surgery. Re-occlusion occurred in 0 in group I but in four (9.8%) in group II. The mRS was good with 0–2 in 38 (82.6%) patients in group I and in 27 (75%) patients in group II, with no significant (P = 0.78) difference. In conclusion, chronic long-segment ICA occlusion can be safely and efficiently recanalized with the endovascular and hybrid surgery. The location of ICA occlusion may have a critical role in determining the recanalization rate, and careful evaluation of the occlusion location may be helpful in increasing the prognosis of recanalization.

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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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Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment

Cited by 3 publications

References 104 publications

Comparison of the treatment strategies for symptomatic chronic internal carotid artery occlusion

Comparison of the treatment strategies for symptomatic chronic internal carotid artery occlusion

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

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

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