Carotid endarterectomy alone or combined with fogarty catheter embolectomy for chronic symptomatic occlusion of the internal carotid artery

Abstract

Objective To investigate the therapeutic effect of carotidendarterectomy(CEA) alone or combined with Fogarty catheter embolectomy in the treatment of chronic symptomatic internal carotid artery occlusion. Methods From April 2008 to December 2013, 12 patients with transient ischemic attack (TIA) or minor stroke underwent digital subtraction angiograph to confirmation t of ICA occlusion. All patients underwent operative exploration with CEA or CEA plus Fogarty thrombectomy. Patients who failed revascularization underwent external CEA and ICA ligation. All clinical and radiological data were retrospectively reviewed. Results CEA in 7 patients and CEA plus Fogarty thrombectomy in 3 patients were performed successfully to restore blood flow of internal carotid artery. External CEA and internal carotid artery ligation were performed in 2 patients. Postoperative CT angiography or DSA imaging demonstrated patency of the internal carotid artery in 10 patients. The ischemic symptoms were relieved in most of the patients. Postoperatively, 3 patients suffered from hyperperfusion syndrome, but there were no perioperative stroke or death.The duration of follow-up was 15-66 months. No patient developed a new stroke. No re-occlusion but one mild re-stenosis(40%) was detected. 2 patients suffered from TIA occasionally.One of the two patients failed in recanalization relieved from the symptom, the another still suffered from TIA. Conclusions Carotid endarterectomy alone or combined with Fogarty catheter embolectomy to treat chronic symptomatic internal carotid artery occlusion is feasible and safe, but preoperative evaluation and selection of patient should be carefully. Key words: Carotid artery, internal; Arterial occlusive diseases; Endarterectomy, carotid; Embolectomy; Fogarty catheter