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Ischemic Stroke
Original research
Endovascular recanalization of chronically occluded internal carotid artery
  1. Federico Cagnazzo,
  2. Pierre-Henri Lefevre,
  3. Imad Derraz,
  4. Cyril Dargazanli,
  5. Gregory Gascou,
  6. Carlos Riquelme,
  7. Raed Ahmed,
  8. Alain Bonafe,
  9. Vincent Costalat
  1. Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France
  1. Correspondence to Dr Federico Cagnazzo, Neuroradiology Department, CHRU Gui de Chauliac, Montpellier 34000, France; f.cagnazzo86{at}gmail.com

Abstract

Background It is debated whether endovascular treatment is indicated for a symptomatic chronically occluded internal carotid artery (COICA).

Objective To assess outcomes after endovascular treatment of COICA.

Methods We performed a systematic search of three databases (PRISMA guidelines), including endovascular series of COICA. Outcomes were analyzed with random-effects models.

Results We included 13 studies and 528 endovascularly treated patients with COICA. Successful recanalization was 72.6% (347/528, 95% CI 65.4% to 79.9%, I2=68.9%). Complications were 18% (88/516, 95% CI 12.1% to 23.8%, I2=65%), with 5% (25/480, 95% CI 2% to 7%, I2=0%) of permanent events, and 9% (43/516, 95% CI 6% to 13%, I2=34%) of thromboembolisms. Treatment-related mortality was 2% (11/516, 95% CI 0.5% to 2.6%, I2=0%). Shorter duration of the occlusion was associated with higher recanalization: 80% (11/516, 95% CI 54% to 89%, I2=0%), 63% (33/52, 95% CI 49% to 76%, I2=0%), and 51% (18/35, 95% CI to 37% to 88%, I2=40%) recanalization rates for 1, 3, and >3 months occlusions, respectively. Complications were 6% (3/50, 95% CI 3% to 21%, I2=0%), 14% (4/27, 95% CI 5% to 26%, I2=0%), and 25% (13/47, 95% CI 10% to 30%, I2=0%) for 1, 3, and >3 months occlusions, respectively. Patient aged <70 years presented higher revascularization rates (OR=3.1, 95% CI 1.2 to 10, I2=0%, p=0.05). Successful reperfusion was higher (OR=5.7, 95% CI 1.2 to 26, I2=60%, p=0.02) and complications were lower (OR=0.2, 95% CI 0.6 to 0.8, I2=0%, p=0.03) for lesions limited to the cervical internal carotid artery compared with the petrocavernous segment. Successful recanalization significantly lowered the rate of thromboembolisms (OR=0.2, 95% CI 0.8 to 0.6, I2=0%, p=0.01) and mortality (OR=0.5, 95% CI 0.1 to 0.9, I2=0%, p=0.04), compared with conservative treatment.

Conclusions Endovascular treatment of COICA gives a 70% rate of successful recanalization, with 5% morbidity. Patients aged <70 years, lesions limited to the cervical internal carotid artery, and a shorter duration of the occlusion decreased the risk of complications. Successful recanalization of symptomatic lesions lowered by about 80% the likelihood of thromboembolisms, compared with medical management.

  • dissection
  • stenosis
  • stent
  • stroke

http://dx.doi.org/10.1136/neurintsurg-2019-015701

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    Footnotes

    • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: FC, P-HL, CD, ID, GG, CR, RA, AB, VC. Drafting the work or revising it critically for important intellectual content: FC, P-HL, VC. Final approval of the version to be published: FC, P-HL, CD, ID, RA, GG, CR, AB, VC. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: FC, P-HL, CD, ID, GG, RA, CR, AB, VC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. Data from a meta-analysis of the literature.