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, Hsien Li Kao

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Abstract

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. METHODS AND 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.

Original languageEnglish
Pages (from-to)119-125
Number of pages7
JournalCirculation. Cardiovascular interventions
Volume1
Issue number2
Publication statusPublished - Oct 2008
Externally publishedYes

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Internal Carotid Artery
Blood Vessels
Safety
Stroke
Mortality
False Aneurysm
Brain Ischemia
Neuroimaging
Documentation
Hypotension
Cognition
Fistula
Ischemia

ASJC Scopus subject areas

  • Medicine(all)

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Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion. / Lin, Mao Shin; Lin, Lung Chun; Li, Hung Yuan; Lin, Cheng Hsin; Chao, Chi Chao; Hsu, Chih Neng; Lin, Yen Hung; Chen, Shih Chung; Wu, Yen Wen; Kao, Hsien Li.

In: Circulation. Cardiovascular interventions, Vol. 1, No. 2, 10.2008, p. 119-125.

Research output: Contribution to journalArticle

Lin, Mao Shin ; Lin, Lung Chun ; Li, Hung Yuan ; Lin, Cheng Hsin ; Chao, Chi Chao ; Hsu, Chih Neng ; Lin, Yen Hung ; Chen, Shih Chung ; Wu, Yen Wen ; Kao, Hsien Li. / Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion. In: Circulation. Cardiovascular interventions. 2008 ; Vol. 1, No. 2. pp. 119-125.
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T1 - Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion.

AU - Lin, Mao Shin

AU - Lin, Lung Chun

AU - Li, Hung Yuan

AU - Lin, Cheng Hsin

AU - Chao, Chi Chao

AU - Hsu, Chih Neng

AU - Lin, Yen Hung

AU - Chen, Shih Chung

AU - Wu, Yen Wen

AU - Kao, Hsien Li

PY - 2008/10

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N2 - 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. METHODS AND 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.

AB - 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. METHODS AND 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.

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