Abstract
Abstract WP176: Recanalization of Chronically Occluded Internal Carotid Artery
Stroke (1970), Vol.50(Suppl_1)
02/2019
DOI: 10.1161/str.50.suppl_1.WP176
Abstract
Objective: The overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%-7% per year despite receiving the best medical therapy. We propose a radiographic classification of COICA that can be used as a guide to determine the technical success and safety of endovascular recanalization for symptomatic COICA.
Methods: The radiographic images of 100 consecutive subjects with COICA were analyzed. A new classification of COICA was proposed based on the morphology, location of occlusion, and presence or absence of reconstitution of the distal ICA. The classification was used to predict successful revascularization in 32 symptomatic COICAs in 31 patients. Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy.
Results: Four types (A-D) of radiographic COICA were identified. Types A and B were more amenable to safe revascularization than types C and D. Recanalization was successful at a rate of 68.75% (22/32 COICAs; type A: 8/8; type B: 8/8; type C: 4/8; type D: 2/8). The perioperative complication rate was 18.75% (6/32; type A: 0/8 [0%]; type B: 1/8 [12.50%]; type C: 3/8 [37.50%], type D: 2/8 [25.00%]). None of these complications led to permanent morbidity or death. Twenty (64.52%) of 31 subjects had improvement in their symptoms at the 2-6 months' follow-up. A statistically significant decrease in systolic blood pressure (SBP) was noted in 17/21 (80.95%) patients who had successful revascularization, which persisted on follow-up (p = 0.0001). The remaining 10 subjects in whom revascularization failed had no significant changes in SBP (p = 0.73).
Conclusions: The pilot study suggested that our proposed classification of COICA may be useful as an adjunctive guide to determine the technical feasibility and safety of revascularization for symptomatic COICA using endovascular techniques. Additionally, successful revascularization may lead to a significant decrease in SBP postprocedure. A Phase 2b trial in larger cohorts to assess the efficacy of endovascular revascularization using our COICA classification is warranted.
Details
- Title: Subtitle
- Abstract WP176: Recanalization of Chronically Occluded Internal Carotid Artery
- Creators
- David M Hasan - Iowa Hosps and CL Univ, Iowa City, IAMario Zanaty - Iowa Hosps and CL Univ, Iowa City, IARobert M Starke - Univ of Miami, Miami, FLNohra Chalouhi - Thomas Jefferson Univ Hosp, Philadelphia, PAPascal Jabbour - Thomas Jefferson Univ Hosp, Philadelphia, PAWaldo Guerrero - Iowa Hosps and CL Univ, Iowa City, IADaichi Nakagawa - Iowa Hosps and CL Univ, Iowa City, IAEdgar A Samaniego - Iowa Hosps and CL Univ, Iowa City, IANnenna Mbabuike - Mayo Clinic, Jacksonville, FLRabih Tawk - Mayo Clinic, Jacksonville, FLAdnan H Siddiqui - Univ of Buffalo, Buffalo, NYElad I Levy - Univ of Buffalo, Buffalo, NYRobin Novakovic - UT Southwestern Med Cntr, Dallas, TXJonathan White - UT Southwestern Med Cntr, Dallas, Dallas, TXClemens M Shirmer - Geisinger, Danville, PAThomas G Brott - Mayo Clinic, Jacksonville, FLHussain Shallwani - Univ of Buffalo, Buffalo, NYL Nelson Hopkins - Univ of Buffalo, Buffalo, NY
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.50(Suppl_1)
- DOI
- 10.1161/str.50.suppl_1.WP176
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2019
- Academic Unit
- Neurology; Iowa Neuroscience Institute; Otolaryngology; Roy J. Carver Department of Biomedical Engineering; Radiology; Neurosurgery
- Record Identifier
- 9984071953302771
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