Abstract
Introduction
Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods.
Methods
A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset.
Results
Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration.
Conclusion
In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed.
Similar content being viewed by others
References
Yadav JS, Wholey MH, Kuntz RE et al Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501
Qureshi AI, Kirmani JF, Divani FA, Hobson RW II (2005) Carotid angioplasty with or without stent placement versus carotid endarterectomy for treatment of carotid stenosis: a meta-analysis. Neurosurgery 56:1171–1181
Terada T, Yamaga H, Tsumoto T, Masuo O, Itakura T (2005) Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. Case report. J Neurosurg 102:558–564
Lyden P, Brott T, Tilley B et al (1994) Improved reliability of the NIH Stroke Scale using video training. Stroke 25:2220–2226
Spearman MP, Jungreis CA, Wechsler LR (1995) Angioplasty of the occluded internal carotid artery. AJNR Am J Neuroradiol 16:1791–1796
Wang H, Lanzino G, Fraser K, Tracy P, Wang D (2003) Urgent endovascular treatment of acute symptomatic occlusion of the cervical internal carotid artery. J Neurosurg 99:972–977
Duber C, Klose KJ, Kopp H, Schmiedt W (1992) Percutaneous transluminal angioplasty for occlusion of the subclavian artery: short- and long-term results. Cardiovasc Intervent Radiol 15:205–210
Gonzalez A, Gil-Peralta A, Gonzalez-Marcos JR, Mayol A (2002) Angioplasty and stenting for total symptomatic atherosclerotic occlusion of the subclavian or innominate arteries. Cerebrovasc Dis 13:107–113
Green DW, Sanchez LA, Parodi JC et al (2005) Acute thromboembolic events during carotid artery angioplasty and stenting: etiology and a technique of neurorescue. J Endovasc Ther 12:360–365
Schonholz CJ, Uflacker R, Mendaro E et al (2005) Techniques for carotid artery stenting under cerebral protection. J Cardiovasc Surg (Torino) 46:201–217
Ohki T, Parodi J, Veith FJ et al (2001) Efficacy of a proximal occlusion catheter with reversal of flow in the prevention of embolic events during carotid artery stenting: an experimental analysis. J Vasc Surg 33:504–509
Asakura F, Kawaguchi K, Sakaida H et al (2006) Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices. Neuroradiology 17:1–13
Sievert H, Rabe K (2002) Role of distal protection during carotid stenting. J Interv Cardiol 15:499–504
Sasoh M, Ogasawara K, Kuroda K et al (2003) Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 59:455–460
Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhupl K (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81:236–244
The EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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). https://doi.org/10.1007/s00234-006-0126-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-006-0126-8