Document Detail

Protected endovascular revascularization of subacute and chronic total occlusion of the internal carotid artery.
MedLine Citation:
PMID:  19850764     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The natural course of symptomatic carotid artery occlusion with hemodynamic impairment is poor. Surgical revascularization may improve the outcome; however, its efficacy has not been established yet. The goal of this study was to characterize the technical and clinical outcomes following endovascular recanalization of the ICA under cerebral circulatory protection. MATERIALS AND METHODS: Endovascular recanalization was attempted in 8 patients with symptomatic ICA occlusions. The duration of the occlusion ranged from 7 days to 7 months (mean, 2.5 months), and the mean length of the occlusion was 95 mm. Cerebral hemodynamics ipsilateral to the side of the occlusion were severely impaired in all patients. The endovascular procedure was performed under total cerebral circulatory protection, beginning with proximal protection with a subsequent switch to distal protection after successful guidewire passage. RESULTS: The occlusion was recanalized successfully in 7 of 8 patients (88%), resulting in improvement of ipsilateral cerebral hemodynamics without symptomatic stroke. Small asymptomatic ischemic lesions were detected in 6 of 8 patients (75%) on DWI, and 1 patient developed a mild groin hematoma. Ischemic episodes did not recur during the mean follow-up period of 19 months. However, 1 patient experienced asymptomatic reocclusion, which was re-treated successfully without complications, while another patient developed mild retinal hemorrhage at 3 months after the procedure due to the combination of antiplatelet and anticoagulant therapy. CONCLUSIONS: Endovascular revascularization of an ICA occlusion is feasible and well-tolerated in patients with subacute or chronic total occlusion of the ICA.
M Shojima; S Nemoto; A Morita; T Miyata; K Namba; Y Tanaka; E Watanabe
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2009-10-22
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  31     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-16     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  481-6     Citation Subset:  IM    
Department of Endovascular Neurosurgery, Jichi Medical University, Tochigi, Japan.
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MeSH Terms
Arterial Occlusive Diseases / radiography,  therapy*
Carotid Stenosis / radiography,  therapy*
Cerebral Angiography
Cerebral Revascularization / methods*
Cerebrovascular Circulation
Chronic Disease
Follow-Up Studies
Middle Aged
Severity of Illness Index
Stroke / prevention & control

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