Vascular Diameters as Predictive Factors of Recanalization Surgery Outcomes in Internal Carotid Artery Occlusion.

Chengrui Yan,Rong Wang,Yang Zhao,Jiaru Wang,Weitao Jin,Ruohan Guo

doi:10.3389/fneur.2021.632063

Abstract

Background: Revascularization surgery sometimes can achieve recanalization in patients with internal carotid artery occlusion (ICAO). High-resolution vessel wall magnetic resonance imaging (HRVWI) is a feasible technique to give detailed characteristics of the vessel wall, which may help to identify patients that carry higher success rates and more suitable for revascularization surgery.Objective: To examine the association between HRVWI characteristics of ICAO and the success rate of revascularization surgery in ICAO patients.Methods: We conducted a retrospective analysis of 31 ICAO recanalization patients enrolled from October 2017 to May 2019. The clinical data of patients and lesions were collected and analyzed.Results: A total of 31 ICAO patients were enrolled in this study. No significant differences were found between recanalization success and recanalization failure groups with regard to occlusion length, distal end of the occluded segment, and the treatment applied. The ipsilateral-to-contralateral diameter ratios (I/C ratios) of C1 or C2 and the diameter of C7 were positively related to recanalization success. A two-factor predictive model was constructed, and the I/C ratio of C2 < 0.86 and the diameter of C7 < 1.75mm were separately assigned 1 point. The ICAO patients who scored 0, 1, or 2 points had a risk of 5.6% (1/18), 55.6% (5/9), or 100% (4/4) to fail in the recanalization.Conclusions: The I/C ratios of C1 or C2 and the diameter of C7 are predictive factors of a revascularization surgery success in ICAO patients. A risk stratification model involving C2 and C7 was constructed for future clinical applications.

Highlights

Chronic internal carotid artery occlusion (ICAO) was usually formed based on progressive atherosclerosis at the bifurcation of the carotid artery [1]
Extracranialintracranial or intracranial collateral circulation established during the progression could compensate the compromised perfusion, which accounts for the fact that some patients are asymptomatic despite severe ICA stenosis or ICAO
Years old; [2] diagnosed as symptomatic total occlusion or nearocclusion of the carotid artery by digital subtraction angiography (DSA); [3] the latest stroke occurred more than 8 weeks previously, and patients with more than two ipsilateral cerebral ischemia were given optimal medical treatment; [4] patients should have accepted a high-resolution vessel wall magnetic resonance imaging (HRVWI) examination with contrast before the procedure

Summary

Introduction

Chronic internal carotid artery occlusion (ICAO) was usually formed based on progressive atherosclerosis at the bifurcation of the carotid artery [1]. Extracranialintracranial or intracranial collateral circulation established during the progression could compensate the compromised perfusion, which accounts for the fact that some patients are asymptomatic despite severe ICA stenosis or ICAO. Both symptomatic and asymptomatic ICAO patients are at high risk for stroke. Carotid endarterectomy (CEA) could directly revascularize the narrow or occluded ICA and improve intracranial blood flow It applies to the cases with a short occlusive length in the extracranial part of ICA, with a recanalization rate of 40.7– 87.5% [4]. Length of occlusion, occlusion duration, plaque location, and distal ICA reconstitution at a higher segment might affect the success rates [3]. High-resolution vessel wall magnetic resonance imaging (HRVWI) is a feasible technique to give detailed characteristics of the vessel wall, which may help to identify patients that carry higher success rates and more suitable for revascularization surgery

Methods

Results

Conclusion