Analysis of failure in endovascular recanalization of chronic internal carotid artery occlusion

Abstract

Objective To analyze the causes and possible influence factors of endovascular recanalization failure of chronic internal carotid artery occlusion (CICAO). Methods One hundred and three patients with CICAO underwent endovascular recanalization in Department of Interventional Neurology in Beijing Tiantan Hospital, Capital Medical University were selected from December 2012 to December 2019. The factors possibly related to failure (including sex, age, underlying disease, time from occlusionto recanalization, the shape of the stump and the position of the reflux) were analyzed. Univariate and multivariate Logistic regression analysis were used to screen for influence factors related to the failure of recanalization. Results In 103cases,there were33 patients who failed in recanalization, the failurerate was 32.04%. One case (0.97%) occurred subarachnoid hemorrhage which induced severe headache during operation. Logistic regression analysis showed thatthe stump ofthe occluded ICA was non⁃pointed (OR= 3.037, 95%CI: 1.245-7.406; P=0.015) and the reflux position of the distal ICA was above the cavernous sinus (C4-C6 segment; OR =3.118, 95%CI: 1.206-8.061, P =0.019) were the risk factors for failure of successful rate after endovascular recanalization of CICAO. Of the 33 failure cases, 27 cases (81.82%) were due to guide wires failed to pass through the occlusion segment, which mainly occurred in C4-C5 segment (14 cases, 42.42%) and C1 segment (11 cases, 33.33%); other 6 cases (18.18%) were due to dissection which mainly occurred in C4-C5 segment (5 cases, 15.15%). Conclusions Endovascular recanalization of CICAO is relatively safe and feasible. The stump condition and the position of distal reflux of the occlud ed ICA are the key in judging the difficulty of recanalization.

DOI：10.3969/j.issn.1672⁃6731.2020.06.005