Introduction Surgical carotid revascularization has been described with various degrees of technical and clinical success. Currently, carotid revascularization is not recommended, based on the high potential for embolic stroke during the procedure. The data is however limited to only surgical cases. One series of endovascular revascularization for occluded carotids of unknown length of time has already been communicated. The authors present a similar series using a flow reversal device.
Method During the period of February 2009 to November 2011 a total of 13 patients underwent endovascular revascularization of either single or both occluded carotid arteries. The procedure was done in all cases using a flow reversal system (the Gore flow reversal) In three cases the procedure had to be aborted due to the fact that the occluded segment included part of the supraclinoid carotid. In the rest of cases the procedure was technically feasible succesfully. After revascularization all patients underwent stenting of their extracranial carotids. Two patients had either bilateral occlusions or presented with a non-disabling stroke due to a severe stenosis on one side and a chronic occlusion on the other. In these cases the revascularizations have been performed in stages with a 2–3 month interval in between interventions.
Results There were no neurologic complications related to the procedure either in the successful or in the aborted cases. Two patients developed large inguinal hematomas and had to be transfused.
Conclusion The endovascular revascularization of carotid artery occlusion of unknown duration is feasible using a flow reversal device. Addditional information regarding clinical and imaging indications for the procedure is necessary in order to proper select patients that might benefit. Long term follow-up will also be necessary in order to assess the viability of re-opened carotids as well as risks for stroke in patients after this procedure.
Competing interests None.
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