Endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery: Initial clinical experience and technical considerations

Abstract

Objective To investigate the feasibility, safety and efficacy of endovascular recanalization of symptomatic subacute and chronic occlusion of large intracranial artery. Methods During the period from October 2015 to September 2017, 11 patients with symptomatic subacute and chronic occlusion of large intracranial artery were treated with endovascular recanalization at Department of Interventional Radiology of Shanghai Tongji Hospital, Tongji University School of Medicine. We retrospectively analyzed the patients' clinical and imaging data to evaluate the rate of perioperative complications and follow-up results. Results Recanalization was successful in 10 of 11 patients and incomplete recanalization (2a based on Thrombolysis in Cerebral Infarction classification) was achieved in 1. Intraoperative complications occurred in 8 cases and included peripheral vascular embolism in 7 (1 symptomatic and 6 asymptomatic cases). One case was complicated with artery dissection and intracerebral hemorrhage associated with embolectomy occurred in another case. One patient was lost to follow-up and 10 patients received angiography and clinical follow-up for 3-12 months. The results of angiography follow-up showed that the stenosis artery segment of patient with incomplete recanalization was blocked again at 3 months. Of the 9 patients with complete recanalization, 1 patient developed in-stent restenosis at 12 months and suffered transient ischemic attack (TIA). The other 8 patients had no hemodynamic restenosis and no recurrence of TIA or stroke. The mRS (modified Rankin scale) score at 3-month follow-up was 0-1 in 9 patients and 4 in 1. Conclusions For patients with symptomatic subacute and chronic occlusion of large intracranial artery, on the premise of strict screening cases, mechanical recanalization is technically feasible and could improve the patient' symptoms in short term and reduce the recurrence rate of stroke. Its long-term effect, however, needs to be confirmed by longer follow-up. Key words: Arterial occlusive diseases; Cerebral angiography; Cerebral revascularization; Intraoperative complications