Chronic Internal Carotid Artery Research Articles

Correlation between nova volume flow rate and TOF signal intensity ratio: value in unilateral internal carotid artery occlusion.

Non-invasive optimal vessel analysis quantitative magnetic resonance angiography (NOVA-QMRA) has emerged as a valuable tool to characterize cerebral hemodynamics in intracranial atherosclerotic disease (ICAD). Our aim was to explore the eventual correlation between volume flow rate (VFR) measured via NOVA-QMRA and signal intensity ratio (SIR) of time-of-flight (TOF) MRA in M1- and P2-segments bilaterally in patients with unilateral internal carotid artery (ICA) occlusion. Patients with acute, subacute or chronic unilaterall ICA occlusion receiving NOVA-QMRA between June 2019 and June 2021 were retrospectively included. In bilateral M1- and P2-segments VFR was assessed by means of NOVA-QMRA and a region of interest (ROI) was selected to measure TOF SIR. A correlation between TOF SIR and VFR was tested by means of Pearson correlation coefficient. Mean difference of TOF SIR and VFR between ipsilateral (to occluded ICA) and contralateral M1- and P2-segments was analyzed using a two-sided Welch's t test. Fifty-five patients with unilateral ICA occlusion were included (acute: 28; subacute: 8; chronic: 19). Both ipsilateral (r = 0.536, p < 0.001) and contralateral (r = 0.757, p < 0.001) TOF SIR correlated significantly with NOVA VFR. This observation proved especially true for patients with chronic ICA occlusion. Both VFR (165.18 vs 110.60, p < 0.001) and TOF SIR (4.96 vs 2.70, p < 0.001) were higher in contralateral than ipsilateral M1-segments; whereas, the contrary was observed for P2-segments (VFR 72.35 vs 102.12, p < 0.001, TOF SIR 2.87 vs 3.39, p = 0.016). The study results showed that TOF SIR significantly correlated with phase-contrast derived flow volume in patients with symptomatic ICA occlusion. This correlation remains the same regardless of the stage of the ischemic stroke (acute vs subacute vs chronic). Furthermore, significantly high VFR and TOF SIR in ipsilateral P2-segments may provide evidence of leptomeningeal collateralization in acute patients. Standardly performed TOF SIR Sequences might be of help for a qualitative evaluation of the flow in M1- and P2-segments in patients with unilateral ICA occlusions. NOVA QMRA allows precise quantitative measurements of the flow in cerebral vessels.

Hybrid Surgery for symptomatic chronic internal carotid artery occlusion: a single-center experience.

Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO. This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes. The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100% for revascularization (n = 27), with a perioperative complication rate of 14.8% (n = 4). Following a median follow-up of 6.0months (IQR, 4-10), 21 patients underwent a DSA or CT angiography reexamination, confirming a vascular patency rate of 90.5% (n = 19). One patient required surgery for severe in-stent restenosis, and another experienced asymptomatic occlusion. Clinical follow-ups were conducted for all 26 patients; no new strokes were reported in the qualifying artery territory, with 13 patients scoring 0, 12 scoring 1, and 1 scoring 2 on the mRS. Although hybrid surgery represent a promising option for treating chronic ICAO, they are also associated with a relatively high incidence of treatment-related complications. The application of composite surgery should be based on standardized technical guidelines and the careful selection of patients who are genuinely at high risk for recurrent strokes.

Carotid Stump Syndrome: Rare Cause of Recurrent Stroke Post-Ipsilateral Carotid Occlusion - A Case Report.

Carotid stump is blind remnant of occluded proximal segment of the internal carotid artery (ICA) that can become the potential source of embolism. Carotid stump syndrome is a potentially treatable cause of recurrent ischemic events in the carotid territory in the setting of occlusion of the ipsilateral ICA. It is thought to be caused by turbulent blood flow in the patent stump of the occluded ICA causing microemboli migrating in the brain through external carotid-ophthalmic anastomotic channels and retrograde flow. Here, we report a patient with known ipsilateral chronic ICA occlusion, who was on best medical management, presented on two separate occasions with recurrent embolic infarctions in ipsilateral carotid territory. She was diagnosed with carotid stump syndrome and treated through endovascular route with clinical and angiographic follow-up.

Combination of intraoperative indocyanine green video-angiography FLOW 800 and computed tomography perfusion to assess the risk of cerebral hyperperfusion syndrome in chronic internal carotid artery occlusion patients after revascularization surgery.

To study the changes of corticocerebral hemodynamics in surgical area and postoperative hyperperfusion syndrome in patients with chronic internal carotid artery occlusion (CICAO) by intraoperative indocyanine green videoangiography (ICGA)-FLOW 800 and CT perfusion after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery. From October 2019 to January 2021, 77 patients diagnosed with CICAO underwent direct bypass surgery at Huadong hospital (affiliated with Fudan University) were enrolled. Regions of interest (ROIs) at STA, proximal MCA (PMCA), distal MCA (DMCA), cortical blood capillary (CBC), and cortical vein (CV) were identified after anastomosis by ICGV-FLOW 800 including peak fluorescence intensity (PFI), time to peak (TTP), and area under the time curve (AUC) of fluorescence intensity. All patients underwent perfusion-weighted CT before bypass surgery and those patients with HPS were verified by CTP after bypass. 14 patients with HPS were verified by perfusion-weighted CT after bypass. In HPS group, the AUCTTP of DMCA was significantly larger (T = -3.301, p = 0.004) and TTP of CBC was shorter (T = -2.929, p = 0.005) than patients in non-HPS group. The larger AUCTTP of DMCA (OR = 3.024, 95%CI 1.390-6.578, p = 0.0050) was an independent risk factor by further multivariate logistic regression analysis. The hemodynamic changes of cortical vessels during STA-MCA bypass surgery could be recorded accurately by ICGV-FLOW 800. Furthermore, the increased AUCTTP of DMCA and shorter TTP of CBC may be potential risk factors of HPS.

Recanalization of chronic long-segment occlusion of the internal carotid artery with endovascular and hybrid surgery

To investigate the effect of endovascular and/or hybrid surgical recanalization on chronic long-segment occlusion of the internal carotid artery (ICA) and the effect of occlusion location on the recanalization rate and prognosis, 87 patients with chronic ICA occlusion treated with endovascular approach only or hybrid surgery were retrospectively enrolled. The duration of ICA occlusion ranged from 21 to 360 days (median 30). Type I occlusion (from the neck to below the cavernous segment) consisted of 46 (52.8%) patients while type II (from the neck to above the clinoid segment) of 41 (47.1%). Hybrid surgery was performed in 44 (50.6%) patients while endovascular recanalization only was conducted in the other 43 (49.4%). In all patients, the success rate of recanalization was 93.0% (40/43) for the endovascular approach and 95.5% for the hybrid surgical approach. In patients with type I occlusion, endovascular recanalization only was performed in 22 (47.8%) patients and hybrid surgery in 24 (52.2%), resulting in successful recanalization in all patients (100%). In patients with type II occlusion, the success rate of recanalization was 85.7% (18/21) for the endovascular approach only but 90% (18/20) for the hybrid surgery. The total success rate of recanalization was 94.3% (82/87) for all patients, 100% for type I occlusion, and 87.8% for type II occlusion. No significant (P = 0.12) differences existed in the recanalization rate between groups I and II. Clinical follow-up was performed in 82 (94.3%) patients 6–39 months (mean 16) after the surgery. Re-occlusion occurred in 0 in group I but in four (9.8%) in group II. The mRS was good with 0–2 in 38 (82.6%) patients in group I and in 27 (75%) patients in group II, with no significant (P = 0.78) difference. In conclusion, chronic long-segment ICA occlusion can be safely and efficiently recanalized with the endovascular and hybrid surgery. The location of ICA occlusion may have a critical role in determining the recanalization rate, and careful evaluation of the occlusion location may be helpful in increasing the prognosis of recanalization.

The efficacy of STA-MCA double anastomosis comparing to single anastomosis in chronic internal carotid artery occlusion patients

ObjectiveTo investigate the efficacy of STA-MCA double-anastomosis and single-anastomosis in patients with cerebral hypoperfusion caused by chronic internal carotid artery occlusion(CICAO). MethodsIn this retrospective study, data were collected from 19 patients with CICAO who underwent STA-MCA anastomosis at our hospital between January 2016 and January 2022, and they were divided into single anastomosis group and double anastomosis group according to the surgical method. The study collected general clinical data from both groups, including age, sex, lipid levels, blood pressure, glucose levels, smoking and alcohol consumption. Additionally, pre- and postoperative neurological function, cerebral hemodynamic parameters, and postoperative ischemic events were also recorded. By combining our study findings with the existing literature, a comparative analysis of the efficacy of single- and double-anastomosis in patients with CICAO was conducted. ResultsPrior to surgical treatment，there were no statistically significant differences in cerebral hemodynamic parameters, including rob (0.65 ± 0.09 VS. 0.62 ± 0.04), rut (1.73 ± 0.40 VS. 1.99 ± 0.53), and rTMax (2.02 ± 0.49 VS. 1.72 ± 0.46), as well as neurofunctional scores, including modified Rankin Scale (MRS) (2.8 ± 1.03 VS. 2.4 ± 0.88) and National Institutes of Health Stroke Scale (NIHSS) (9.1 ± 5.08 VS. 8.3 ± 4.09) between the two groups. After operation, rCBF (single: 0.65 ± 0.09 VS.0.84 ± 0.08, p = 0.007; double: 0.62 ± 0.04 VS.1.08 ± 0.20, p = 0.001) were significantly increased in both groups, but the rMTT (1.99 ± 0.53 VS.1.27 ± 0.42, p = 0.0447) and rTMax (1.72 ± 0.46 VS.1.16 ± 0.16, p = 0.038) showed significant differences postoperatively only in the double-anastomosis group. The MRS (single: 1.8 ± 1.23, double: 1.7 ± 0.9) in both groups and the NIHSS (7.2 ± 5.11) in single-anastomosis group were not improved after surgery, while the NIHSS (8.3 ± 4.09 VS.4.4 ± 3.08, p = 0.037) in double-anastomosis group was improve significantly. In summary, the double-anastomosis group showed better improvement in rCBF and NIHSS scores compared to the single-anastomosis group.(ΔrCBF: 0.19±0.09 VS. 0.45±0.18, p=0.02, ΔNIHSS: 1.9±0.56 VS. 4±1.73, p=0.002). The cases were followed up for 20.3 ± 18.6 months, and there were no ischemic events in either group during the follow-up period. ConclusionSTA-MCA revascularization can improve CBF in patients with hypoperfusion caused by CICAO, and prevent the reoccurrence of ischemic stroke effectively. Compared with single-anastomosis, double-anastomosis can provide more CBF and improve neurologic dysfunction.

Endovascular recanalization for symptomatic chronic internal carotid artery occlusion: proposal of a modified angiographic classification and clinical outcomes

PurposeTo stratify angiographic images of chronic internal carotid artery occlusion (CICAO) into a newly modified angiographic classification, and identify suitable candidates for endovascular recanalization. MethodsThis study included 51 consecutive patients with symptomatic CICAO who underwent endovascular recanalization at our institution. Patients’ clinical information, angiographic findings, procedural results, and outcomes were recorded. We attempted to stratify all angiographic images into categories based on morphological occlusive patterns and distal internal carotid artery (ICA) lumen reconstitution on digital subtraction angiography (DSA). ResultsFour types (I–IV) of CICAO were identified based on angiographic characteristics. We defined type I as having a tapered (IA) or blunt stump (IB) and distal ICA lumen reconstitution with collateral filling; type II as having no stump but with distal ICA lumen reconstitution; type III as having a tapered (IIIA) or blunt stump (IIIB) but no distal ICA lumen reconstitution; type IV as having no stump and no distal ICA lumen reconstitution. The rate of successful recanalization was 90.3 % for type I, 60.0 % for type II, 50.0 % for type III, 0 % for type IV, respectively (P = 0.002). The overall intraoperative complication rate was 11.8 %, and none of them led to severe neurological damage or death. The follow-up modified Rankin Scale (mRS) scores were significantly decreased in successfully revascularized patients, whilst there were no significant changes in the other failed patients. ConclusionFor symptomatic CICAO, our newly modified angiographic classification may be comprehensive and useful in selecting suitable patients for recanalization and grading the difficulty of the procedures.

A single-center retrospective study of the COCO technique in the treatment of chronic internal carotid artery occlusion

ObjectiveTo introduce a novel endovascular recanalization method and to investigate its success rate, periprocedural complications, and early outcomes in patients with chronic internal carotid artery occlusion (CICAO). As this novel...

Influence of the integrity of circle of Willis on asymptomatic or mild patients with first diagnosed chronic internal carotid artery occlusion

BackgroundIn order to identify individuals with chronic internal carotid artery occlusion (CICAO), it is essential to understand the integrity of the circle of Willis (CoW). This understanding is important as it may determine the potential benefits of active medical and endovascular treatments. PurposeThe objective of this study is to assess whether diminished integrity of the CoW can serve as a useful marker for identifying individuals with more severe impairment in cerebral blood perfusion and a higher incidence of cerebral infarction among asymptomatic or mildly affected patients with CICAO. Materials and MethodsWe conducted a retrospective review of asymptomatic or mildly affected patients with newly diagnosed CICAO who did not receive reperfusion therapies. The categorization of patients into good or poor integrity groups was based on the assessment of CoW integrity using CTA. We evaluated the volume and value of prolonged time to peak (TTP) in both groups, as well as the occurrence of new cerebral infarctions. Our analysis involved multivariate regression and receiver operating characteristic (ROC) analysis. ResultsHemodynamic abnormalities characterized by prolonged TTP were observed in the affected side's blood supply region in all 38 patients. There was a notable difference in the volume and value of prolonged TTP between the two groups (P < 0.001). Correlation analyses based on CTP and CTA parameters revealed a negative relationship between CoW scores and both the abnormal volume (r = –0.624, P = 0.000) and value (r = –0.589, P = 0.000) of prolonged TTP. Upon multivariable adjustment, the independent predictors for new cerebral infarction and higher volume of prolonged TTP were solely the CoW status, with respective estimates of (b = 6.05; 95% confidence interval [CI]: 1.619, 22.619; P = 0.007) and (b = 35.486; 95% CI: 4.697, 268.088; P = 0.001). ConclusionAssessing the integrity of the CoW is crucial in evaluating abnormal perfusion in asymptomatic or mildly affected individuals who are newly diagnosed with CICAO and have not undergone reperfusion therapy.

Hybrid surgery recanalization for high-level chronic internal carotid artery occlusion.

Although endovascular recanalization is considered a more effective treatment for chronic internal carotid artery occlusion (CICAO), the success rate of complex CICAO remains inadequate. We present hybrid surgery (carotid endarterectomy combined with carotid stenting) for complex CICAO and explore the influential factors and effects of hybrid surgery recanalization. We retrospectively analyzed the clinical, imaging, and follow-up data of 22 patients with complex CICAO treated by hybrid surgery at the Zhongnan Hospital of Wuhan University from December 2016 to December 2020. We also summarize the technical points related to hybrid surgery recanalization. A total of 22 patients with complex CICAO underwent hybrid surgery recanalization. There were no postoperative deaths in all patients after hybrid surgery recanalization. Nineteen patients successfully underwent recanalization with a success rate of 86.4% and three cases with a failure rate of 13.6%. Patients were divided into success and failure groups. Significantly different radiographic classification of lesions was observed between the success group and the failure group (P = 0.019). The rates of CICAO with reverse ophthalmic artery blood flow in the internal carotid artery (ICA) preoperatively were 94.7% in the success group and 33.3% in the failure group (P = 0.038). Three cases of hybrid surgery recanalization failure were transferred for EC-IC bypass and had good neurological recovery. Postoperative average KPS scores of the 19 patients were improved compared to the preoperative ones (P < 0.001). Hybrid surgery for complex CICAO is safe and effective with a high recanalization rate. The recanalization rate is related to whether the occluded segment surpasses the ophthalmic artery.

Related factors of successful endovascular therapy in patients with chronic internal carotid artery occlusion

The clinical data of 73 symptomatic patients with chronic internal carotid artery occlusion (CICAO) who underwent endovascular therapy in the Second Affiliated Hospital of Soochow University and Suzhou Ninth People's Hospital from January 2011 to May 2019 were retrospectively analyzed, and the related factors of successful endovascular therapy were determined. The patients were divided into recanalization group (49 cases) and non-recanalization group (24 cases). The related factors of successful endovascular recanalization in patients with symptomatic CICAO were investigated by both univariate and multivariate logistic regression analyses. The results showed that distal ICA reconstitution at the clinoid segment (OR=8.946, 95%CI: 1.782-44.910) and tapered stump (OR=4.488, 95%CI: 1.147-17.566) were related factors of successful endovascular therapy in patients with CICAO (both P<0.05). However, calcification at the beginning of occluded ICA (OR=0.161, 95%CI: 0.027-0.965) was an adverse factor for successful endovascular therapy in patients with CICAO (P<0.05). This study indicates that the related factors of successful ICA endovascular therapy in patients with symptomatic CICAO mainly include tapered stump and distal ICA reconstitution at the clinoid segment, while calcification at the beginning of occluded ICA was an adverse factor.

Hemodynamic Changes in Patients with Chronic Internal Carotid Artery Occlusion After Recanalization.

This study aimed to investigate the feasibility and clinical efficacy of endovascular recanalization in patients with chronic internal carotid artery occlusion (CICAO) and explore the application value of computed tomography perfusion (CTP) in endovascular recanalization. This non-randomized controlled study included 41 patients with CICAO. All patients received active medical treatment. In this study, patients with successful endovascular recanalization and those who refused endovascular recanalization were included in the recanalization and medication groups, respectively. Before and 90 days after treatment, cognitive function was evaluated using the Montreal Cognitive Function Assessment, and neurological function was evaluated using the National Institutes of Health Stroke Scale and modified Rankin scale. For patients with successful endovascular recanalization, brain CTP imaging was performed to evaluate hemodynamic changes in patients with CICAO before and three days after treatment. Overall, 41 symptomatic patients with CICAO were included, and 20 patients received endovascular recanalization therapy, with a success rate of 60% (12/20). The perioperative complication rate was 15% (3/20); there were no events such as hyperperfusion, distal embolism, vascular rupture, or cerebral hemorrhage, and no stroke-related or death-related events. Patients were divided into a medication group (n=21) and recanalization group (n=12). After 90 days of follow-up, patients in the recanalization group showed greater improvement in overall cognitive and neurological function. In addition, successful endovascular recanalization significantly improved cerebral blood perfusion on the occluded side of patients with CICAO. Successful recanalization can effectively improve the overall cognitive and neurological functions of patients in the short term. CTP can be used to quantitatively evaluate not only the cerebral hemodynamic changes after internal carotid artery occlusion but also the improvement of cerebral blood perfusion after successful endovascular recanalization, which provides a reliable method for postoperative follow-up.

Abstract Number ‐ 66: Symptomatic Chronic Internal Carotid Artery Occlusion Managed With Bilateral Common Carotid Angioplasty: A Case Report

Introduction Several guidelines have addressed symptomatic or asymptomatic carotid artery stenosis treatment with intensive medical management and surgical management based on the severity of stenosis [1]. In acute occlusions, endovascular treatment (EVT) and carotid endarterectomy (CEA) with or without prior thrombolytics provide the best recanalization and functional outcomes when compared to intravenous or intra‐arterial thrombolysis alone. There is, however, less robust evidence on management of symptomatic chronic internal carotid artery (ICA) occlusion occurring in tandem with significant contralateral ICA stenosis [2]. In chronic ICA occlusion (ICAO), EVT and carotid endarterectomy (CEA) are technically unfeasible, but indirect procedures have been arising as safe and effective alternatives, notably CEA or stenting of contralateral stenotic ICA [3] and CEA or stenting of ipsilateral external carotid artery (ECA) [4]. We hereby report a case of symptomatic chronic ICAO that was managed with staggered angioplasty and stenting of bilateral common carotid artery (CCA) bifurcations. Methods We hereby present a case report. Results A 62‐year‐old male with atrial fibrillation and hypertension woke up with sudden dysarthria and right upper extremity and facial weakness. NIHSS at presentation was 4. Last seen normal 9 hours prior. Non‐contrast head computerized tomography (CT) did not show acute intracranial abnormality, CT angiogram of head and neck showed severe right ICA stenosis and complete occlusion of the left ICA at cervical, petrous and cavernous segments, with distal reconstitution at the supraclinoid segment with left proximal middle cerebral artery (MCA) thrombus. CT perfusion showed a core infarct volume of 8cc in left MCA territory, mismatch volume of 78cc and ratio of 10.8. Risks of acute neuro‐intervention were deemed to outweigh benefits. Given favorable perfusion imaging, and in concordance with the EXTEND trial [5], tPA was administered. The patient remained stable without hemorrhagic complications with residual deficits of mild right upper extremity weakness and mild expressive aphasia. MRI confirmed left ICA territory ischemic infarcts. Patient underwent stenting of the asymptomatic right ICA at the CCA bifurcation first, followed by left CCA stent after one month with impressive improvement in subsequent perfusion imaging. Conclusions Our case encourages consideration of well‐timed angioplasty and stenting in cases of chronic bilateral carotid artery disease especially when the asymptomatic side is also significantly stenotic

Morphological and Compositional Features of Chronic Internal Carotid Artery Occlusion in MR Vessel Wall Imaging Predict Successful Endovascular Recanalization.

Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI was performed within 1 week prior to surgery for evaluating the following features: proximal stump morphology, extent of occlusion, occlusion with collapse, arterial tortuosity, the presence of hyperintense signals (HIS) and calcification in the occluded C1 segment. Multivariate logistic regression was used to identify features associated with technical success and construct a prediction model. Results: Eighty-three patients were recruited, of which fifty-seven (68.7%) were recanalized successfully. The morphological and compositional characteristics of CICAO were associated with successful recanalization, including occlusions limited to C1 and extensive HIS, as well as the absence of extensive calcification, absence of high tortuosity, and absence of artery collapse. The MR CICAO score that comprised the five predictors showed a high predictive ability (area under the curve: 0.888, p < 0.001). Conclusion: the MR-VWI characteristics of CICAO predicted the technical success of endovascular recanalization and may be leveraged for identifying patients with a high probability of successful recanalization.

Spotlight on clinical strategies of Chronic Internal Carotid Artery Occlusion: Endovascular interventions and external-intracarotid bypasses compared to conservative treatment.

Chronic internal carotid artery occlusion (CICAO) has high prevalence and incidence rates, and patients with CICAO can be completely asymptomatic, experience a devastating stroke or die. It is important to note that CICAO causes cerebrovascular accidents. Currently, the external carotid-internal carotid (EC-IC) bypass technique is used to treat CICAO. However, many clinical studies showed that EC-IC bypass was not beneficial for many patients with CICAO. Meanwhile, endovascular intervention treatment options for CICAO are evolving, and an increasing number of patients are undergoing endovascular intervention therapy. Accordingly, a review comparing both techniques is warranted. For this review, we searched PubMed and collected relevant case study reports comparing endovascular interventional therapy and internal and external cervical bypass surgeries to provide strategies for clinical treatment.

Related factors of internal border-zone infarcts in patients with symptomatic chronic internal carotid artery occlusion

Objective: To explore the related factors of internal border-zone (IBZ) infarcts in patients with symptomatic chronic internal carotid artery occlusion (CICAO). Methods: From January 2011 to May 2019, the symptomatic CICAO patients in the Second Affiliated Hospital of Soochow University and the Ninth People's Hospital of Suzhou were retrospectively analyzed. The patients were divided into IBZ group and non-IBZ group. The demographic data, laboratory examination and imaging data of the two groups were collected. Binary logistic regression analysis was used to identify the related factors of IBZ infarcts in patients with symptomatic CICAO. Results: A total of 185 patients (147 males and 38 females) were finally enrolled, with a mean age of (65±11) years old. There were 64 and 121 cases in IBZ group and non-IBZ group, respectively. The ratio of patients with ophthalmic artery (OA) reflux in IBZ group was 64.1% (41/64), which was significantly higher than that in non IBZ group [47.8% (55/121), P=0.037], while the ratio of patients with collateral compensation (ASTIN/SIR 3-4) in non-IBZ group was 66.1% (80/121), which was significantly higher than that in IBZ group [29.7% (19/64), P<0.001]. Multivariate logistic regression analysis showed that history of cerebral infarction (OR=2.233, 95%CI: 1.023-4.874), low density lipoprotein (LDL) (OR=1.516, 95%CI: 1.006-2.285) and OA reflux (OR=5.060, 95%CI: 1.160-22.081) were independent risk factors for IBZ infarcts in patients with symptomatic CICAO (all P<0.05); while prothrombin international normalized ratio (INR) (OR=0.010, 95%CI: 0.000-0.970) and collateral compensation (ASTIN/SIR 3-4) (OR=0.172, 95%CI: 0.079-0.373) were protective factors (all P<0.05). Conclusion: OA reflux, LDL, and history of cerebral infarction are independent risk factors for IBZ infarcts in patients with symptomatic CICAO, while INR and collateral compensation scores (ASTIN/SIR 3-4) are the protective factors.

Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients with Chronic Internal Carotid Artery Occlusion Complicated by Cerebral Infarction.

PurposeThis study aims to investigate the prognostic value of the peripheral neutrophil-to-lymphocyte ratio (NLR) in patients with chronic internal carotid artery occlusion (CICAO) complicated by cerebral infarction.Patients and MethodsThe clinical data of 99 CICAO patients complicated by cerebral infarction were retrospectively analyzed. The modified Rankin Scale (mRS) was used to assess their 3-month prognosis, and a multivariate logistic regression model was established to explore risk factors for poor prognosis.ResultsMultivariate logistic regression analysis demonstrated that NLR (OR=2.114; 95% CI: 1.129–3.959) and baseline National Institute of Health Stroke Scale (NIHSS; OR=1.288, 95% CI: 1.053–1.574) score were risk factors of poor prognosis. The area under the receiver operator characteristic (ROC) curve of NLR in predicting the 3-month outcome after onset was 0.717 (95% CI: 0.606–0.828, P<0.000). The optimal cut-off value was 3.22, with a sensitivity of 0.743 and a specificity of 0.791.ConclusionNLR is an independent risk factor for the poor prognosis of CICAO patients complicated by cerebral infarction and can serve as an indicator for clinical prognosis.

The additional value of high-resolution vessel wall imaging in screening suitable chronic internal carotid artery occlusion candidates for endovascular recanalization: comparison with digital subtraction angiography.

High-resolution vessel wall imaging (HR-VWI) can provide information about exact occluded length, etiology, and the presence of intraluminal thrombus or residual cavity. To investigate the extra value of HR-VWI in screening patients with chronic internal carotid artery occlusion (CICAO) for recanalization suitability in comparison with digital subtraction angiography (DSA). We retrospectively reviewed patients who underwent endovascular recanalization with no internal carotid artery signal on magnetic resonance angiography (MRA) and whose both preoperative DSA and HR-VWI data were available. Patients were classified into type I (focal occlusion distal to ophthalmic artery), type II or III (occlusion proximal or at/distal to clinoid segment), and near-occlusion. Occlusion etiology and suitability for recanalization were analyzed both on preoperative DSA and HR-VWI. Accuracy of occlusion classification and differences in the modified Rankin scale scores between the baseline and follow-up were estimated. A total of 20 patients were included. With intraoperative DSA as the gold standard, we found HR-VWI could additionally show intraluminal thrombi. Preoperative DSA misclassified one near-occlusion, one type I occlusion, and one type II occlusion as type III occlusions, and one near-occlusion as a type II occlusion. Therefore, compared with the preoperative DSA, three additional cases were successfully recanalized based on HR-VWI. The accuracy of HR-VWI was higher than preoperative DSA (100% vs. 80%). Prognosis improvement of type I was significantly better than type II and near-occlusion (P<0.05). HR-VWI can identify occluded etiology, extent, and classification of CICAO. This information is potentially useful in screening candidates for endovascular recanalization and helpful to indicate prognosis.

Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion: A single-center retrospective study.

ObjectiveChronic internal carotid artery occlusion (CICAO) can cause transient ischemic attack (TIA) and ischemic stroke. Carotid artery stenting (CAS) with embolic protection devices and hybrid surgery combining carotid endarterectomy and endovascular treatment are effective methods for carotid revascularization. The objective of this study was to evaluate and compare the effect and safety of the two surgical procedures.MethodsThis was a single-center retrospective study. In this study, 44 patients who underwent hybrid surgery and 35 who underwent endovascular intervention (EI) at our center were enrolled consecutively between May 2016 and March 2022. All patients were classified into four groups (A-D), as described by Hasan et al. We recorded and analyzed clinical data, angiographic characteristics, technical success rate, perioperative complications, and follow-up data.ResultsThere was no significant difference in baseline characteristics between hybrid surgery group and EI group, except for plasma high density lipoproteins (HDL) levels (median [interquartile range]: hybrid surgery, 0.99 [0.88–1.18] vs. EI, 0.85 [0.78–0.98] mmol/L, P = 0.001). The technical success rate of hybrid surgery was higher than that of EI (37/44 [84.1%] vs. 18/35 [51.4%], P = 0.002; type A: 15/16 [93.8%] vs. 10/11 [90.9%], P = 1.000; type B: 9/10 [90.0%] vs. 5/7 [71.4%], P = 0.537; type C: 12/15 [80.0%] vs. 3/12 [25.0%], P = 0.004; type D: 1/3 [33.3%] vs. 0/5 [0%], P = 0.375). No significant difference was observed in the incidence of perioperative complications between the two procedures (hybrid surgery: 7/44 [15.9%] vs. EI: 6/35 [17.1%], P = 0.883). In addition, there were no significant differences in the rates of stroke and restenosis during follow-up.ConclusionsFor patients with symptomatic CICAO, hybrid surgery may have an advantage over EI in successfully recanalizing occluded segments. There was no significant difference in safety and restenosis between hybrid surgery and EI.

High-resolution magnetic resonance imaging for predicting successful recanalization in patients with chronic internal carotid artery occlusion.

ObjectiveThe main aim of the study was to investigate the predictive factors of high-resolution magnetic resonance imaging (HR-MRI) for successful recanalization in patients with chronic internal carotid artery occlusion (CICAO).MethodsWe included 41 consecutive patients who had CICAO and underwent recanalization attempts. The demographics, clinical data, and HR-MRI features in relation to the technique success were collected and analyzed using univariate and multivariate analyses. A score-based prediction model was constructed using a regression coefficient-based scoring method.ResultsTechnical success was achieved in 26 (63.4%) patients, with a complication rate of 12.2% (5/41). Based on multivariate analysis, occlusions involving ophthalmic artery segment (C6) or above (OR: 0.036; 95% confidence interval [CI]: 0.004–0.336) and nontapered stump (OR: 0.064; 95% CI: 0.007–0.591) were identified as independent negative predictors of successful recanalization in patients with CICAO. Point scores were assigned according to the model coefficients, and the patients who scored 0, 1, or 2 points had success rates of 93.33% (14/15), 66.67% (12/18), or 0% (0/8), respectively.ConclusionHR-MRI characteristics may be valuable in identifying candidates for endovascular recanalization in patients with CICAO. Occlusions involving the C6 segment or higher, as well as nontapered stumps, were independent negative predictors of technical success.