Published Online
on September 3, 2008

A more recent version of this article appeared on October 1, 2008

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Original Article

Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion

Mao-Shin Lin¹; Lung-Chun Lin¹; Hung-Yuan Li¹; Cheng-Hsin Lin²; Chi-Chao Chao¹; Chih-Neng Hsu³; Yen-Hung Lin¹; Shih-Chung Chen⁴; Yen-Wen Wu³ and Hsien-Li Kao^3,5

¹ National Taiwan University Hospital, Taipei, Taiwan;
² Chi-Mei Medical Center, Tainan, Taiwan;
³ National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan;
⁴ Taipei Medical University and Wan-Fang Hospital, Taipei, Taiwan

⁵ E-mail: hsienli_kao{at}yahoo.com

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 hereafter report acute and early follow-up results of 54 chronic ICAO patients undergoing endovascular recanalization, focusing on potential vascular complications and corresponding management.

Methods and Results—Endovascular recanalization for chronic ICAO was attempted in 54 consecutive patients (48 men; 69.2 ± 9.8 years old) with either recurrent neurologic deficit or objective ipsilateral hemisphere ischemia. Mean duration from occlusion documentation to the procedure was 237 ± 327 days (limits 56 to 1424 days). In-hospital and 3-month adverse events were recorded. Successful recanalization was achieved in 35 patients (65%, 35/54). 3-months cumulative stroke/death rate was 4% (2/54), including 1 in-hospital fatal non-ipsilateral stroke and 1 in-hospital minor ipsilateral stroke secondary to systemic hypotension. Vascular complications developed in 3 patients (6%, 3/54), including 1 late pseudo-aneurysm 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 sequel was noted with close follow-up and adequate management.

Conclusion—Certain immediate or delayed vascular complications may develop during or after the endovascular recanalization for chronic ICAO. Although peri-procedural death and stroke rate is limited in our series, further study combining neuro-imaging tools and cognitive function evaluation is mandatory to assess its utility and appropriateness in patients with chronic ICAO.

Key Words: angioplasty • carotid arteries • occlusion • stroke • endovascular recanalization

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Carotid Stenting for Chronic Total Occlusion of the Internal Carotid Artery: Dogma Debunked?

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Circ Cardiovasc Interv 2008 1: 93-94. [Extract] [Full Text] [PDF]

Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion

Mao-Shin Lin, Lung-Chun Lin, Hung-Yuan Li, Cheng-Hsin Lin, Chi-Chao Chao, Chih-Neng Hsu, Yen-Hung Lin, Shih-Chung Chen, Yen-Wen Wu, and Hsien-Li Kao
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