Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage

Abstract

A symptomatic internal carotid artery (ICA) occlusion with hemodynamic compromise was treated at its chronic stage by using an endovascular technique. An embolic protection system was used during the recanalization procedure to prevent stroke by reversing the flow from the distal ICA to the common carotid artery. The totally occluded ICA was completely recanalized through percutaneous transluminal angioplasty and stent placement. The patient's symptom (transient ischemic attack) disappeared completely after treatment with no new neurological deficit. Single-photon emission computerized tomography findings confirmed improvement of the hemodynamic compromise, and no new high-intensity spots appeared on diffusion-weighted magnetic resonance imaging after treatment. This case shows that endovascular recanalization by using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise and refractoriness to antiplatelet therapy, even in the chronic stage of the illness.

Wire-Probing Technique to Revascularize Subacute or Chronic Internal Carotid Artery Occlusion

“…More recently, a few reports demonstrated successful recanalization of chronically occluded carotid arteries with acceptable feasibility and safety [4][5][6][7][8][9][10] . however, this procedure can be difficult because there is no visualization of the route to guide the devices through the occluded segment.…”

Angioplasty and Stenting of Totally Occluded Common Carotid Artery at the Chronic Stage -Case Report-

“…4,5) Surgical revascularization with extracranial-intracranial bypass is effective in improving hemodynamic impairment. However, surgical reconstruction is not straightforward for total occlusion of the common carotid artery (CCA), and the effectiveness remains unclear.…”

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

“…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.…”