Carotid Recanalization in Nonacute Internal Carotid Artery Occlusion

Abstract

Ipsilateral chronic carotid occlusion (CCO) can be found in up to 15% of patients with transient ischemic attacks (TIAs) and strokes. 1,2 Cervical occlusion is a morbid diagnosis with a high risk (6%-20%) of recurrent strokes and ipsilateral strokes (2%-9.5%). 3-5 The subgroup of patients with severe hemodynamic compromise with CCO is at a higher risk for such events. 6 The effectiveness of percutaneous transluminal angioplasty and stenting of the extracranial carotid artery is improving as a result of the development of autoexpandable prostheses and new systems of cerebral protection. 7 Currently, this technique constitutes a true alternative to carotid endarterectomy in the treatment of a severe degree of carotid stenosis with a minimum risk of cerebral embolization. 8-10 We attempted endovascular recanalization in select patients with CCO and retrograde ophthalmic artery flow. 11 We present an early report on the safety and efficacy of endovascular recanalization in symptomatic CCO. In this study, we evaluate the safety and efficacy of endovascular recanalization in CCO with severe hemodynamic compromise. METHODS We performed a retrospective review of patients with symptomatic CCO. We identified 39 patients with CCO who were admitted to our institution after suffering an ischemic event, stroke, or TIA. Neurological evaluation included preprocedural and postprocedural clinical examination and neuropsychological tests. 12 In addition to routine neurological examinations, we focused on cognitive function. We used the Rankin Scale to measures disability scores, the National Institutes of Health Stroke Scale to detect focal disorder, and the Barthel Scale to evaluate functional incapacity. Minor stroke was defined as an increase in the National Institutes of Health Stroke Scale score of ,3 with complete resolution or no significant disability at 30 days. Major stroke was defined as an increase in the National Institutes of Health Stroke Scale score of $ 3 with significant disability at 30 days. Neuropsychological tests included global cognitive function (Mini-Mental State Examination of Folstein,