Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion.
BACKGROUND
Patients with chronic cervical internal carotid artery occlusion (ICAO) and cerebral ischemia may benefit from revascularization. The feasibility of endovascular recanalization for chronic ICAO has been reported recently, but its safety is still unproven. We report the follow-up results of 54 chronic ICAO patients who underwent endovascular recanalization, focusing on potential vascular complications and corresponding management.


RESULTS
Endovascular recanalization for chronic ICAO was attempted in 54 consecutive patients (48 men; 69.2 + or - 9.8 years old) with either recurrent neurological deficit or objective ipsilateral hemisphere ischemia. Mean duration from occlusion documentation to the procedure was 237 + or - 327 days (range, 56 to 1424 days). Adverse events while in the hospital and during the 3-month follow-up were recorded. Successful recanalization was achieved in 35 of 54 patients (65%). Three-month cumulative stroke and death rate was 4% (2 of 54), including 1 in-hospital fatal nonipsilateral stroke and 1 in-hospital minor ipsilateral stroke secondary to systemic hypotension. Vascular complications developed in 3 of 54 patients (6%), including 1 late pseudoaneurysm formation 3 months after recanalization, 1 immediate carotid-cavernous fistula after recanalization, and 1 minor extravasation at carotid bifurcation after failed recanalization. However, no clinical sequela was noted with close follow-up and adequate management.


CONCLUSIONS
Certain immediate or delayed vascular complications may develop during or after the endovascular recanalization for chronic ICAO. Although periprocedural death and stroke rate is limited in our study, further study combining neuroimaging tools and cognitive function evaluation is mandatory to assess its utility and appropriateness in patients with chronic ICAO.
Lin
Mao-Shin
MS
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Lin
Lung-Chun
LC
Li
Hung-Yuan
HY
Lin
Cheng-Hsin
CH
Chao
Chi-Chao
CC
Hsu
Chih-Neng
CN
Lin
Yen-Hung
YH
Chen
Shih-Chung
SC
Wu
Yen-Wen
YW
Kao
Hsien-Li
HL
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D001270:Cervical Atlas / Q000098:blood supply; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome