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Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 177-180. doi: 10.19723/j.issn.1671-167X.2020.01.028

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Hybrid treatment for symptomatic long-segment chronic internal carotid artery occlusion without stump

Zi-chang JIA1,Xuan LI1,Mei ZHENG2,Jing-yuan LUAN1,Chang-ming WANG1,Jin-tao HAN1,△()   

  1. 1. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-02-20 Online:2020-02-18 Published:2020-02-20
  • Contact: Jin-tao HAN E-mail:bmucystal@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81200969)

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Abstract:

Objective: To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump. Methods: Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. Results: In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the pro-ximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment. Conclusion: Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.

Key words: Carotid stenosis, Carotid artery,internal, Stents, Angioplasty

CLC Number: 

  • R543.4

Figure 1

DSA image showed long-segment chronic internal carotid artery occlusion without stump pre-operation, development of distal segment of C4 was observed by collateral compensation of ophthalmic artery"

Figure 2

DSA image showed long-segment of internal carotid artery occlusion was successfully recanalized post-operation"

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