Benign outcome of objectively proven spontaneous recanalization of internal carotid artery occlusion.
OBJECTIVE
Spontaneous recanalization of intracranial internal carotid artery (ICA) occlusion is frequent in embolic strokes. Spontaneous recanalization of the extracranial portion of the ICA occlusion of atherosclerotic or embolic origin is only anecdotally reported, and data are lacking about its incidence, natural history, and outcome in long-term follow-up.


METHODS
Consecutive patients with ICA occlusion were prospectively identified and followed-up to detect the incidence of a spontaneous recanalization. Patients with objectively confirmed recanalization were prospectively followed-up to observe their natural history and the onset of new cerebrovascular events. ICA occlusion and spontaneous recanalization were diagnosed by means of color-coded Doppler ultrasound imaging or selective contrast angiography, or both. All patients were evaluated and treated for atherosclerotic risk factors.


RESULTS
Spontaneous recanalization occurred in 16 of 696 patients (2.3%; 95% confidence interval, 1.3%-3.7%) with ICA occlusion after a mean interval of 38 months from the diagnosis of occlusion. Spontaneous recanalization was detected with color-coded Doppler ultrasound imaging and with selective contrast angiography, with a complete agreement of diagnostic findings. Two patients presented with symptomatic spontaneous recanalization. All patients with spontaneous recanalization were asymptomatic after a mean follow-up of 66.2 months.


CONCLUSIONS
Spontaneous recanalization of previously occluded extracranial ICAs is more frequent than anticipated. Once it occurs, spontaneous recanalization seems to have a benign long-term course.
Unit of Angiology, University Hospital of Padua, Padua, Italy. giuseppe.camporese@sanita.padova.it
Giuseppe
G
Camporese
Nicos
N
Labropoulos
Fabio
F
Verlato
Enrico
E
Bernardi
Roberto
R
Ragazzi
Giovanna
G
Salmistraro
Dimitrios
D
Kontothanassis
Giuseppe Maria
GM
Andreozzi
D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002641:Chicago; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012075:Remission, Spontaneous; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media