Preliminary experience of endovascular revascularization for chronic long segment internal carotid artery occlusion

Objective: To explore the feasibility, safety and effect of endovascular revascularization for chronic long segment internal carotid artery occlusion. Methods: The cases of chronic long segment internal carotid artery occlusion who were treated by endovascular revascularization in our center from May 2015 to April 2017 were reviewed. Eleven cases met the inclusion criteria: the duration of the occlusion was more than three weeks and the segment of the occlusion was beyond the petrosal segment of internal carotid arteries from the initial segment. All of the cases had the related symptoms and had declining cerebral perfusion. The analysis index included: baseline information, radiological information, perioperative results, clinical follow-up and imaging follow-up. The imaging follow-up index were the re-stenosis or re-occlusion of the revascularized artery. Results: The occlusion was recanalized successfully in 9 of 11 patients, the two procedures were abandoned after repeated attempts and the guide wire could not reach the true lumen when navigating in the cavernous segment. Six cases of the nine successfully recanalized cases accepted perfusion-weighted imaging scan. Cerebral perfusion of all the cases were improved. Thrombus shifting was observed in one case and occluded a subbranch, mechanical thrombectomy was performed successfully, the case was recovered well without sequela. No symptomatic stroke or death was happened in the perioperative period. All of the nine cases who successfully recanalized acquired clinical follow-up, median follow-up time was ten months (4-28 months). No ischemic stroke and death happened after the procedures. Seven of nine cases improved in the clinical symptoms. Five cases accepted the imaging follow-up. The meantime was six months. No re-occlusion was happened. Conclusions: Endovascular revascularization for chronic long segment internal carotid artery occlusion is feasible, safe, and short-term effective. More clinical research is needed to verify the long-term effect. (authors)