Imaging Identification and Prognosis of the Distal Internal Carotid Artery With Near and Complete Occlusion After Recanalization.

Tao Sun,Donghai Wang,Chao Wang,Mengtao Han,Fei Wang,Yiming He,Yunyan Wang,Xingang Li

doi:10.3389/fneur.2020.630028

Abstract

Background and Purpose: Previous studies have mainly focused on treatment strategies and clinical outcomes for internal carotid artery near occlusion (ICANO) and internal carotid artery complete occlusion (ICACO). However, reports on the morphological changes of distal internal carotid artery (ICA) after recanalization are scarce. This study aimed at illustrating identifying features, assessing prognosis of the distal ICA after recanalization, and exploring best practices for treatment for ICANO and ICACO.Materials and Methods: We retrospectively studied the clinical characteristics of 57 patients with ICANO or ICACO who underwent surgical recanalization. The clinical data, angiographic morphology, technical successful rate, perioperative complications, and the lumen changes of distal ICA before and after successful recanalization were analyzed.Results: Fifty-two patients who achieved successfully recanalization were studied. Based on the postoperative lumen diameter changes in the distal ICA, 19 cases were classified as distal-dilatation and the remaining 33 as distal-narrowness. Patients in the distal-narrowness group mostly had ICACO (21.1 vs. 54.5%) and were men (68.4 vs. 93.9%). In the distal-narrowness group, the lumen of the distal ICA recovered to normal in 32 of the 33 patients during the follow-up period. Of the 32 patients reviewed, the ICA of 28 patients dilated back to normal after 1 week of surgery; the ICA of remaining patients 4 dilated 2 weeks postoperatively.Conclusions: Narrowness of the distal ICA after hybrid recanalization was more prevalent in male patients with ICACO. Homogeneous stenosis of the whole course of the distal ICA is a low-perfusion narrowness which does not require intervention and will spontaneously recover after successful recanalization with an increase in the forward flow.

Highlights

Near occlusion of internal carotid artery (ICANO), known as pseudo-occlusion, subtotal occlusion, string sign of the internal carotid artery (ICA), describes a phenomenon of an obvious reduction of the artery diameter beyond the stenotic lesion in an ICA with severe stenosis [1, 2]
We retrospectively studied the medical records of patients with symptomatic internal carotid artery near occlusion (ICANO) or chronic ICA severe stenosis progresses to complete occlusion (ICACO) treated at our institution between December 2015 and April 2020
ICANO is diagnosed if patients meet the following criteria: [1] delayed imaging of the ICA compared with that of the external carotid artery (ECA); [2] contrast agent filled the intracranial branches of the ICA via collateral circulation, usually via the ophthalmic artery; [3] obviously reduced diameter of the ICA [2]

Summary

Introduction

Near occlusion of internal carotid artery (ICANO), known as pseudo-occlusion, subtotal occlusion, string sign of the internal carotid artery (ICA), describes a phenomenon of an obvious reduction of the artery diameter beyond the stenotic lesion in an ICA with severe stenosis [1, 2] It represents a critical stenotic state before ICA severe stenosis progresses to complete occlusion (ICACO). Drug therapy is still the preferred treatment in treating carotid ICANO and ICACO, but ischemic symptoms refractory to medical therapy are an indication for revascularization [5,6,7]. We retrospectively analyzed the angiographic characteristics, illustrated identifying features of the two lesions, and we investigated the postoperative short-term change in the diameter of the distal ICA to explore best practices for treatment of ICANO and ICACO. This study aimed at illustrating identifying features, assessing prognosis of the distal ICA after recanalization, and exploring best practices for treatment for ICANO and ICACO

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Conclusion