Predictors for Successful Endovascular Intervention in Chronic Carotid Artery Total Occlusion.
This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO).



Endovascular recanalization in patients with chronic CAO has been reported to be feasible, but technically challenging.



Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. We analyzed potential variables including epidemiology, symptomatology, angiographic morphology, and interventional techniques in relation to the technical success.



The technical success rate was 61.6%. Multivariate analysis showed absence of prior neurologic event (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10 to 0.76), nontapered stump (OR: 0.18; 95% CI: 0.05 to 0.67), distal internal carotid artery (ICA) reconstitution via contralateral injection (OR: 0.19; 95% CI: 0.05 to 0.75), and distal ICA reconstitution at communicating or ophthalmic segments (OR:0.12; 95% CI: 0.04 to 0.36) to be independent factors associated with lower technical success. Point scores were assigned proportional to model coefficients, and technical success rates were >80% and <40% in patients with scores of ≤1 and ≥4, respectively. The c-indexes for this score system in predicting technical success was 0.820 (95% CI: 0.748 to 0.892; p < 0.001) with a sensitivity of 84.7% and a specificity of 67.9%.



Absence of prior neurologic event, nontapered stump, distal ICA reconstitution via contralateral injection, and distal ICA reconstitution at communicating or ophthalmic segments were identified as independent negative predictors for technical success in endovascular recanalization for CAO.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ying-Hsien
YH
Chen
Pantai Hospital Ipoh, Malaysia.
Weng-San
WS
Leong
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan.
Mao-Shin
MS
Lin
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ching-Chang
CC
Huang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chi-Sheng
CS
Hung
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hung-Yuan
HY
Li
KPJ Penang Specialist Hospital, Penang, Malaysia.
Kok-Kheng
KK
Chan
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chih-Fan
CF
Yeh
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Jang
MJ
Chiu
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hsienli_kao@yahoo.com.
Hsien-Li
HL
Kao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003661:Decision Support Techniques; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
carotid artery; chronic total occlusion; endovascular stenting; predictors; scoring system