Endovascular Treatment of Chronic Total Occlusion of the Internal Carotid Artery

• Published in: Nōshotchū no geka Vol. 42; no. 2; pp. 109 - 115
• Main Authors: ABIKO, Masaru, NAKANO, Shigeki, NISHIZAKI, Takafumi, SAKAKURA, Takanori, IKEDA, Norio
• Format: Journal Article
• Language: English; Japanese
• Published: The Japanese Society on Surgery for Cerebral Stroke 2014
• Subjects: chronic total occlusion; endovascular treatment; internal carotid artery; proximal balloon protection
• ISSN: 0914-5508; 1880-4683; 1880-4683
• DOI: 10.2335/scs.42.109

EC-IC bypass based on the inclusion criteria of Japanese EC-IC Bypass Trial (JET study) is recommended for chronic total occlusion (CTO) of the internal carotid artery (ICA). But patients who do not meet the inclusion criteria of the JET study are also entitled to the best possible medical treatment. Recently several authors have reported the successful endovascular recanalization of CTO of the ICA. We report 10 cases of symptomatic CTO of the ICA that did not meet the inclusion criteria of the JET study that were treated by endovascular recanalization. Cerebral angiogram showed complete occlusion of the ICA and opacification of the cavernous segment of ICA or the more proximal portion of the ICA via collateral channels. Xenon CT (Xe-CT) showed hemodynamic compromise in all cases. The endovascular procedure was performed by proximal balloon protection of the common carotid arery and the external carotid artery via transfemoral route under local anesthesia. The occlusion of the ICA was recanalized successfully in all cases. Carotid artery stenting (CAS) was performed in eight cases identified as occlusion at the cervical ICA, and percutaneous transluminal angioplasty (PTA) with stenting using coronary stents was performed in two cases identified as occlusion at the cavernous or petrous ICA. Neither new ischemic symptoms nor hyperperfusion syndrome appeared after treatment. Endovascular recanalization of symptomatic CTO of the ICA can be considered as an alternative treatment for patients who do not meet the inclusion criteria of the JET study.