Abstract
BackgroundStudies on the recanalization for occlusion of the internal carotid artery terminus are scattered. Recently, drug-coated balloon (DCB) has been increasingly applied in the intracranial artery occlusion and achieved encouraging results. However, there seems no convincing data for the nonacute symptomatic internal carotid artery terminus occlusion (sICATO).ObjectiveTo assess the feasibility and effectiveness (safety) of DCB for patients with nonacute sICATO refractory to medical therapy.ApproachThis study included 30 patients with nonacute sICATO treated with DCBs and/or remedial stenting. The rate of successful recanalization, periprocedural complications, and clinical and vascular imaging follow-up outcomes were retrospectively analyzed.ResultsDrug-coated balloon (DCB) dilatation of nonacute sICATO gives a 100% rate of successful recanalization, with a low complication rate (10.00%), good clinical outcomes (86.20%), low restenosis/reocclusion rate (3.45%), and one asymptomatic ipsilateral infarction (3.45%).ConclusionDrug-coated balloon dilation seems to be the promising treatment option for nonacute sICATO considering its safety and feasibility.
Highlights
Intracranial atherosclerosis (ICAS) is an important cause of stroke leading to permanent damage to the brain, especially among Asian populations
digital subtraction angiography (DSA) showed favorable patency of distal vasculature and collateral circulation, MRI depicted infarctions located at the cortical or subcortical borderzone territory and small infarction core shown on diffusion-weighted imaging (DWI) with a large area of low perfusion of internal carotid artery (ICA) territory assessed by arterial spin labeling (ASL)
Our results suggest that patients with an occlusion of the ICA terminus had a high rate of successful recanalization, low periprocedural major complications, and better follow-up patency rates
Summary
Intracranial atherosclerosis (ICAS) is an important cause of stroke leading to permanent damage to the brain, especially among Asian populations. Nonacute internal carotid artery occlusion (ICAO) may cause fluctuating clinical symptoms, namely, minor/major stroke or recurrent transient ischemic attack, or asymptomatic [1]. Symptomatic cerebral ischemia associated with ipsilateral ICAO occlusion accounts for 5–8% of a recurrent ischemic stroke every year [2, 3]. Drug-Coated Balloon: Experience and Outcome patients with compromised hemodynamic status, recurrent stroke risk increases to ∼12% per year [4], even as high as 86% in a 7-year follow-up study [5]. Indication for endovascular treatment and the techniques used were not standardized It is recommended among symptomatic patients with stage I or II hemodynamic failure [7]. Studies on the recanalization for occlusion of the internal carotid artery terminus are scattered. There seems no convincing data for the nonacute symptomatic internal carotid artery terminus occlusion (sICATO)
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