Endovascular Treatment of Chronic Total Occlusion of the Internal Carotid Artery
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...
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| Published in | Nōshotchū no geka Vol. 42; no. 2; pp. 109 - 115 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
The Japanese Society on Surgery for Cerebral Stroke
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 1880-4683 |
| DOI | 10.2335/scs.42.109 |
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| Abstract | 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. |
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| AbstractList | 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. |
| Author | IKEDA, Norio ABIKO, Masaru SAKAKURA, Takanori NAKANO, Shigeki NISHIZAKI, Takafumi |
| Author_xml | – sequence: 1 fullname: ABIKO, Masaru organization: Department of Neurosurgery, Ube Industries Central Hospital – sequence: 1 fullname: NAKANO, Shigeki organization: Department of Neurosurgery, Ube Industries Central Hospital – sequence: 1 fullname: NISHIZAKI, Takafumi organization: Department of Neurosurgery, Ube Industries Central Hospital – sequence: 1 fullname: SAKAKURA, Takanori organization: Department of Neurosurgery, Ube Industries Central Hospital – sequence: 1 fullname: IKEDA, Norio organization: Department of Neurosurgery, Ube Industries Central Hospital |
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| Cites_doi | 10.1111/j.1552-6569.2008.00212.x 10.1161/hs0901.095692 10.1016/j.surneu.2006.02.037 10.1016/j.jacc.2006.11.029 10.1161/CIRCINTERVENTIONS.108.772350 10.1007/s00234-006-0126-8 10.3171/jns.2005.102.3.0558 10.3171/jns.2003.99.3.0504 10.1227/01.NEU.0000073547.86747.F3 10.1161/01.STR.0000135024.54608.3f 10.3174/ajnr.A1843 10.1002/ccd.20489 10.2335/scs.30.434 10.3171/2009.6.JNS09125 |
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| References | 1) Bhatt A, Majid A, Kassab M, et al: Chronic total symptomatic carotid artery occlusion treated successfully with stenting and angioplasty. J Neuroimaging 19: 68-71, 2009 7) Kuroda S，Houkin K，Kamiyama H, et al: Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke 32: 2110-2116, 2001 13) Stone GW, Colombo A, Teirstein PS, et al: Percutaneous recanalization of chronically occluded coronary arteries: procedural techniques, devices, and results. Catheter Cardiovasc Interv 66: 217-236, 2005 8) Lin MS, Lin LC, Li HY, et al: Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion. Circ Cardiovasc Interv 1: 119-125, 2008 12) Shojima M, Nemoto S, Morita A, et al: Protected endovascular revascularization of subacute and chronic total occlusion of the internal carotid artery. AJNR Am J Neuroradiol 31: 481-486, 2010 11) 篠原幸人，小川 彰，鈴木則宏，ほか：脳梗塞慢性期．脳卒中治療ガイドライン2009，協和企画，東京，2009, pp126-127 14) Terada T，Yamaga H, Tsumoto T, et al: Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. J Neurosurg 102: 558-564, 2005 4) Kao HL, Lin MS, Wang CS, et al: Feasibility of endovascular recanalization for symptomatic cervical internal carotid artery occlusion. J Am Coll Cardiol 49: 765-771, 2007 10) Ogasawara K, Yukawa H, Kobayashi M, et al: Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg 99: 504-510, 2003 15) Terada T, Okada H, Nanto M, et al: Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage. J Neurosurg 112: 563-571, 2010 16) Thomas AJ, Gupta R, Tayal AH, et al: Stenting and angioplasty of the symptomatic chronically occluded carotid artery. AJNR Am J Neuroradiol 28: 168-171, 2007 5) Kobayashi N, Miyachi S, Hattori K, et al: Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note. Neuroradiology 48: 847-851, 2006 9) Ogasawara K, Konno H, Yukawa H, et al: Transcranial regional cerebral oxygen saturation monitoring during carotid endarterectomy as a predictor of postoperative hyperperfusion. Neurosurgery 53: 309-314, 2003 3) JET Study Group. Japanese EC-IC Bypass Trial（JET Study）中間解析結果（第二報）．脳卒中の外科 30: 434-437, 2002 2) Flaherty ML, Flemming KD, McClelland R, et al: Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up. Stroke 35: e349-e352, 2004 6) Komiyama M, Yoshimura M, Honnda Y, et al: Percutaneous angioplasty of a chronic total occlusion of the intracranial internal carotid artery. Case report. Surg Neurol 66: 513-518, 2006 11 12 13 14 15 16 1 2 3 4 5 6 7 8 9 10 |
| References_xml | – reference: 14) Terada T，Yamaga H, Tsumoto T, et al: Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. J Neurosurg 102: 558-564, 2005 – reference: 10) Ogasawara K, Yukawa H, Kobayashi M, et al: Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg 99: 504-510, 2003 – reference: 2) Flaherty ML, Flemming KD, McClelland R, et al: Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up. Stroke 35: e349-e352, 2004 – reference: 12) Shojima M, Nemoto S, Morita A, et al: Protected endovascular revascularization of subacute and chronic total occlusion of the internal carotid artery. AJNR Am J Neuroradiol 31: 481-486, 2010 – reference: 16) Thomas AJ, Gupta R, Tayal AH, et al: Stenting and angioplasty of the symptomatic chronically occluded carotid artery. AJNR Am J Neuroradiol 28: 168-171, 2007 – reference: 5) Kobayashi N, Miyachi S, Hattori K, et al: Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note. Neuroradiology 48: 847-851, 2006 – reference: 13) Stone GW, Colombo A, Teirstein PS, et al: Percutaneous recanalization of chronically occluded coronary arteries: procedural techniques, devices, and results. Catheter Cardiovasc Interv 66: 217-236, 2005 – reference: 4) Kao HL, Lin MS, Wang CS, et al: Feasibility of endovascular recanalization for symptomatic cervical internal carotid artery occlusion. J Am Coll Cardiol 49: 765-771, 2007 – reference: 9) Ogasawara K, Konno H, Yukawa H, et al: Transcranial regional cerebral oxygen saturation monitoring during carotid endarterectomy as a predictor of postoperative hyperperfusion. Neurosurgery 53: 309-314, 2003 – reference: 11) 篠原幸人，小川 彰，鈴木則宏，ほか：脳梗塞慢性期．脳卒中治療ガイドライン2009，協和企画，東京，2009, pp126-127 – reference: 15) Terada T, Okada H, Nanto M, et al: Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage. J Neurosurg 112: 563-571, 2010 – reference: 6) Komiyama M, Yoshimura M, Honnda Y, et al: Percutaneous angioplasty of a chronic total occlusion of the intracranial internal carotid artery. Case report. Surg Neurol 66: 513-518, 2006 – reference: 7) Kuroda S，Houkin K，Kamiyama H, et al: Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke 32: 2110-2116, 2001 – reference: 1) Bhatt A, Majid A, Kassab M, et al: Chronic total symptomatic carotid artery occlusion treated successfully with stenting and angioplasty. J Neuroimaging 19: 68-71, 2009 – reference: 8) Lin MS, Lin LC, Li HY, et al: Procedural safety and potential vascular complication of endovascular recanalization for chronic cervical internal carotid artery occlusion. Circ Cardiovasc Interv 1: 119-125, 2008 – reference: 3) JET Study Group. Japanese EC-IC Bypass Trial（JET Study）中間解析結果（第二報）．脳卒中の外科 30: 434-437, 2002 – ident: 1 doi: 10.1111/j.1552-6569.2008.00212.x – ident: 7 doi: 10.1161/hs0901.095692 – ident: 6 doi: 10.1016/j.surneu.2006.02.037 – ident: 4 doi: 10.1016/j.jacc.2006.11.029 – ident: 11 – ident: 8 doi: 10.1161/CIRCINTERVENTIONS.108.772350 – ident: 5 doi: 10.1007/s00234-006-0126-8 – ident: 14 doi: 10.3171/jns.2005.102.3.0558 – ident: 16 – ident: 10 doi: 10.3171/jns.2003.99.3.0504 – ident: 9 doi: 10.1227/01.NEU.0000073547.86747.F3 – ident: 2 doi: 10.1161/01.STR.0000135024.54608.3f – ident: 12 doi: 10.3174/ajnr.A1843 – ident: 13 doi: 10.1002/ccd.20489 – ident: 3 doi: 10.2335/scs.30.434 – ident: 15 doi: 10.3171/2009.6.JNS09125 |
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| Title | Endovascular Treatment of Chronic Total Occlusion of the Internal Carotid Artery |
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