Application of distal filter protection for recanalization therapy in patients with symptomatic internal carotid artery occlusion

Abstract

Objective To investigate the safety and efficacy of distal filter protection for endovascular recanalization in patients with symptomatic internal carotid artery occlusion (ICAO). Methods Retrospective analysis was conducted in patients with symptomatic ICAO screened from the prospectively collected database who underwent endovascular recanalization with distal filters from July 2009 to December 2012. Clinical characteristics, procedural results and outcomes were investigated by reviewing medical records and angiographic data. Totally, twenty three patients were included with the median occlusion time of thirty days (range, 8-510 days). Results Totally in twenty three patients, technical success rate of 96% was obtained in twenty two patients. One filter failed to arrive in distal lumen due to the tortuosity of internal carotid artery. Successful recanalization (TICI 2b-3) was obtained in 18 patients (78%), including 13 patients (57%) with complete (TICI 3) recanalization. Downstream thrombotic clots were observed in two retrieved filters. After procedure, dotted ischemic lesions were detected on MRI in 9(39%) patients and intracranial hemorrhage occurred in 1 patient without neurologic sequelae. No perioperative death or ischemic stroke occurred. At the radiological follow-up of 19.7± 9.3 months and clinical follow-up of 21.0± 8.4 months, in-stent restenosis occurred in one case four months after the procedure and in-stent stenting was performed without complications, and other patients remain uneventful. Conclusion Distal filter protection is safe and feasible for the procedure of endovascular recanalization of symptomatic ICAO. Further clinical investigation and long-term follow-up are warranted to validate its effectiveness. Key words: Carotid artery, internal; Arterial occlusive diseases; Endovascular treatment; Recanalization; Filter protection