Abstract
Rigorous screening and good imaging would help perform surgery on carotid artery occlusion CAO safely and effectively. The purpose of this study was to retrospectively evaluate carotid endarterectomy (CEA) recanalization in patients with common carotid artery occlusion (CCAO) or internal carotid artery occlusion (ICAO) with color Doppler flow imaging (CDFI). A total of 59 patients undergoing CEA were enrolled. According to the results of CEA, the patients were divided into successful recanalization (group A) and unsuccessful recanalization (group B) groups. The original diameter, lesion length, proximal-to-distal diameter ratio and echo characteristics of the lesion within the lumen of the carotid artery were recorded before CEA and compared between the two groups. In regards to the achievement of repatency by CEA, the overall success rate was 74.6% (44/59), the success rate in CCAO patients was 75.9% (22/29) and the success rate in ICAO patients was 73.3% (22/30). There was no significant difference in the success rates between the CCAO and ICAO patients (χ2 = 0.050, P = 0.824). The overall rate of stroke and death within 30 postoperative days was 5.1% (3/59). For the CCAO patients, the lesion length in group A was shorter than that in group B (t = 3.221, P = 0.004). For the ICAO patients, the original diameter of the distal ICA was broader (t = 6.254, P = 0.000) and the proximal-to-distal ICA diameter ratio was smaller (t = 8.036, P = 0.000) in group A than in group B. The rate of recanalization for lumens with a homogeneous echo pattern (hypoecho or isoecho) was significantly higher than that for lumens with echo heterogeneity for both the CCAO and ICAO patients (χ2 = 14.477, P = 0.001; χ2 = 10.519, P = 0.003). However, for both the CCAO and ICAO patients, there was no difference in the rate of recanalization between patients with hypoecho and isoecho lesions (χ2 = 0.109, P = 0.742; χ2 = 0.836, P = 0.429). The original diameter, proximal-to-distal ICA diameter ratio, lesion length and echo characteristics may affect the success of CEA recanalization in patients with CCAO and ICAO. CDFI is helpful in screening patients with carotid artery occlusion and may improve the success rate of CEA.
Highlights
Atherosclerotic carotid artery stenosis or occlusion is a leading cause of ischemic stroke
All patients were evaluated by color Doppler flow imaging (CDFI) before undergoing carotid endarterectomy (CEA), and the CDFI findings were confirmed by digital subtraction angiography (DSA)
A total of 59 patients with common carotid artery occlusion (CCAO) or internal carotid artery occlusion (ICAO) were included in this study, and they underwent magnetic resonance imaging (MRI) or computed tomography (CT) before surgery to determine the presence of intracranial ischemic lesions
Summary
Atherosclerotic carotid artery stenosis or occlusion is a leading cause of ischemic stroke. For patients with acute cerebral stroke caused by carotid artery occlusion (CAO), 40–69% of them develop permanent disability and 16–55% die, and only 2–12% patients have good prognoses [1]. The North American Symptomatic Carotid Endarterectomy Trial (NACET) of the treatment of patients with carotid artery near-occlusion showed that these patients benefit from CEA without an increased risk of stroke [3]. Some studies indicated that the risk of postoperative cerebral hemorrhage was increased by the performance of CEA in these patients [4, 5] due to the enhanced difficulty of the surgical technique, but other studies had different findings [6]. As a non-invasive imaging technique, color Doppler flow imaging (CDFI) can be used to evaluate vessel structures and hemodynamics, which have been proven to aid preoperative screening, intra-operative evaluation and postoperative follow-up [7]
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