Journal article
Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study
Journal of neurosurgery, Vol.130(5), pp.1468-1477
05/2019
DOI: 10.3171/2018.1.JNS172858
PMID: 29775153
Abstract
OBJECTIVEThe overall risk of ischemic stroke from a chronically occluded internal carotid artery (COICA) is around 5%–7% per year despite receiving the best available medical therapy. Here, authors 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 and to assess the changes in systemic blood pressure following successful revascularization.METHODSThe 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, five of whom were female (5/31 [16.13%]). Patients were included in the study if they had a COICA with ischemic symptoms refractory to medical therapy. Carotid artery occlusion was defined as 100% cross-sectional occlusion of the vessel lumen as documented on CTA or MRA and confirmed by digital subtraction angiography.RESULTSFour 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).CONCLUSIONSThe 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
- Feasibility, safety, and changes in systolic blood pressure associated with endovascular revascularization of symptomatic and chronically occluded cervical internal carotid artery using a newly suggested radiographic classification of chronically occluded cervical internal carotid artery: pilot study
- Creators
- David Hasan - 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaMario Zanaty - 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaRobert M Starke - 2Departments of Neurosurgery and Radiology, University of Miami, Miami, FloridaElias Atallah - 3Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PennsylvaniaNohra Chalouhi - 3Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PennsylvaniaPascal Jabbour - 3Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PennsylvaniaAmit Singla - 4Department of Neurosurgery, Covenant Hospital, Waterloo, IowaWaldo R Guerrero - 5Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IowaDaichi Nakagawa - 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaEdgar A Samaniego - 5Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IowaNnenna Mbabuike - 6Department of Neurosurgery, Mayo Clinic-Jacksonville, Jacksonville, FloridaRabih G Tawk - 6Department of Neurosurgery, Mayo Clinic-Jacksonville, Jacksonville, FloridaAdnan H Siddiqui - 7Department of Neurosurgery, University of Buffalo, Buffalo, New YorkElad I Levy - 7Department of Neurosurgery, University of Buffalo, Buffalo, New YorkRoberta L Novakovic - 8Department of Neurosurgery and Neuroradiology, UT Southwestern Medical Center, Dallas, Texas; andJonathan White - 8Department of Neurosurgery and Neuroradiology, UT Southwestern Medical Center, Dallas, Texas; andClemens M Schirmer - 9Department of Neurosurgery, Geisinger, Danville, PennsylvaniaThomas G Brott - 6Department of Neurosurgery, Mayo Clinic-Jacksonville, Jacksonville, FloridaHussain Shallwani - 7Department of Neurosurgery, University of Buffalo, Buffalo, New YorkL. Nelson Hopkins - 7Department of Neurosurgery, University of Buffalo, Buffalo, New York
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.130(5), pp.1468-1477
- DOI
- 10.3171/2018.1.JNS172858
- PMID
- 29775153
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 05/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040396602771
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