Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature

Mario Zanaty; Jorge A Roa; Pascal M Jabbour; Edgar A Samaniego; David M Hasan

doi:10.1016/j.wnsx.2019.100067

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Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature

Journal article

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Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature

Mario Zanaty, Jorge A Roa, Pascal M Jabbour, Edgar A Samaniego and David M Hasan

World neurosurgery: X, Vol.5, pp.100067-100067

01/2020

DOI: 10.1016/j.wnsx.2019.100067

PMCID: PMC6920090

PMID: 31872191

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Abstract

We reviewed the literature on interventions for patients with medically refractory chronically occluded internal carotid artery (COICA) to assess the risks and/or benefits after recanalization via an endovascular technique (ET) or hybrid surgery (HS, i.e., ET plus carotid endarterectomy). A systematic search of the electronic databases was performed. Patients with COICA were classified into 4 different categories according to Hasan et al classification. Eighteen studies satisfied the inclusion criteria. Only 6 studies involved an HS procedure. We identified 389 patients with COICA who underwent ET or HS; 91% were males. The overall perioperative complication rate was 10.1% (95% confidence interval [CI]: 7.4%–13.1%). For types A and B, the successful recanalization rate was 95.4% (95% CI: 86.5%–100%), with a 13.7% (95% CI: 2.3%–27.4%) complication rate. For type C, the success rate for ET was 45.7% (95% CI: 17.8%–70.7%), with a complication rate of 46.0% (95% CI: 20.0%–71.4%) for ET and for the HS technique 87.6% (95% CI: 80.9%–94.4%), with a complication rate of 14.0% (95% CI: 7.0%–21.8%). For type D, the success rate of recanalization was 29.8% (95% CI: 7.8%–52.8%), with a 29.8% (95% CI: 6.1%–56.3%) complication rate. Successful recanalization resulted in a symmetrical perfusion between both cerebral hemispheres, resolution of penumbra, normalization of the mean transit time, and improvement in Montreal Cognitive Assessment (MoCA) score (ΔMoCA = 9.80 points; P = 0.004). Type A and B occlusions benefit from ET, especially in the presence of a large penumbra. Type C occlusions can benefit from HS. Unfortunately, we did not identify an intervention to help patients with type D occlusions. A phase 2b randomized controlled trial is needed to confirm these findings.

Occlusion

Recanalization

Internal Carotid Artery

Stroke

Details

Title: Subtitle: Recanalization of the Chronically Occluded Internal Carotid Artery: Review of the Literature
Creators: Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Jorge A Roa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Pascal M Jabbour - Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
Edgar A Samaniego - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
David M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Resource Type: Journal article
Publication Details: World neurosurgery: X, Vol.5, pp.100067-100067
DOI: 10.1016/j.wnsx.2019.100067
PMID: 31872191
PMCID: PMC6920090
NLM abbreviation: World Neurosurg X
ISSN: 2590-1397
eISSN: 2590-1397
Publisher: Elsevier Inc
Language: English
Date published: 01/2020
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984070206102771

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