Abstract
Abstract WP501: Recanalization of the Occluded Carotid by Endovascular and Hybrid Interventions
Stroke (1970), Vol.51(Suppl_1)
02/2020
DOI: 10.1161/str.51.suppl_1.WP501
Abstract
Introduction:
Patients with medically refractory COICA (chronically occluded internal carotid artery) have an annual stroke risk of 5%-7%, can suffer from cognitive impairment, refractory hypertension, and have decreased quality of life.
Methods:
We reviewed the literature on interventions for COICA patients to assess the risks/benefits after recanalization via endovascular techniques (ETs) or hybrid surgery [ET plus carotid endarterectomy] (HS). Carotid occlusion was defined as 100% stenosis based on DSA. Chronicity was defined as ≥ 1 month of documented occlusion of the ICA. We used the Hasan et al grading system for COICA classification.
Results:
The rate of successful recanalization varied from 60-100%, and that of complications from 0-21.75%. Both rates were classification dependent: for type A and B, the successful recanalization rate using ET was 100.00% with a 5.00% complication rate. For type C, the success rate for ET was 44.44% with a complication rate of 44.44%; however, for the HS, developed to treat specifically type C, the success rate was 88.73% with a major complication rate of 5.66% and a minor complication rate of 7.04%. For type D, the success rate was 25% with a 12.5% complication rate. Successful recanalization leads to an improvement in the neurological symptoms with control of the recurrent ischemic symptoms in 88.0%. Failure to recanalize lead to recurrent T.I.As/strokes 30 days post-procedure in 40% of the patients. Successful recanalization leads to a reversal of systolic hypertension, which was maintained at follow-up in 85.71% (23/27) patients. Bradycardia occurred in 62% (36/69) of ET of COICA, and in 0% of HS, and was classification dependent: 90% of type A, 80% of type B, 44% of type C and 44% of type D. Successful recanalization resulted in symmetrical perfusion between the 2 hemispheres, resolution of penumbra, normalization of the MTT and improvement in MoCA score.
Conclusion:
Type A and B benefited from ET. Type C can benefit from HS. Type D did not benefit from any intervention. A phase 2b randomized controlled trial is needed
Details
- Title: Subtitle
- Abstract WP501: Recanalization of the Occluded Carotid by Endovascular and Hybrid Interventions
- Creators
- Mario Zanaty - UIHC Neurosurgery, Iowa City, IAJorge Roa - UIHC Neurosurgery, Iowa City, IAEdgar Samaniego - Neurology, Radiology, IR, Iowa City, IADavid Hasan - UIHC Neurosurgery, Iowa City, IA
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.51(Suppl_1)
- DOI
- 10.1161/str.51.suppl_1.WP501
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2020
- Academic Unit
- Neurosurgery; Roy J. Carver Department of Biomedical Engineering; Radiology; Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984419125002771
Metrics
1 Record Views