Application of high⁃resolution magnetic resonance imaging vascular wall imaging in endovascular recanalization of chronic internal carotid artery occlusion

Abstract

Objective To explore the application value of high⁃resolution magnetic resonance imaging vascular wall imaging (HR⁃VWI) in endovascular recanalization of chronic internal carotid artery occlusion (CICAO). Methods A total of 11 patients with symptomatic CICAO were treated by recanalization from March 2018 to September 2019. The original and ferminal part of occlusion, and occlusion segment with or without residual lumen, intracavitary thrombosis and arterial dissection were shownto classify accordingto preoperative HR⁃VWI. Type Ⅰ occlusion (ocular segment occlusion), typeⅡ occlusion [occlusion of the internal carotid artery (ICA) bulb to the clinoid process and its proximal intracranial segment] and typeⅢocclusion (occlusion of the ICA bulb to the ocular segment and beyond), and type A occlusion (with residual lumen but without thrombosis or arterial dissection), type B occlusion (residual lumen, thrombus and arterial dissection in residual lumen), type C occlusion (no residual lumen and no thrombus and arterial dissection) and type D occlusion (no residual lumen but with intracavitary thrombosis and arterial dissection) were recorded by with preoperative and intraoperative DSA. The recanalization rate, perioperative complications and prognosis were recorded. Results The preoperative HR⁃VWI showed type Ⅰ occlusion in 2 cases,type Ⅱ occlusion in 6 cases and type Ⅲ occlusion in 3 cases, and type A occlusion in 4 cases, type B occlusion in 2 cases, type C occlusion in one case and type D occlusion in 2 cases. Compared with intraoperative DSA, the positive detection rate of HR⁃VWI for residual lumen, intracavitary thrombosis and arterial dissection was 10/11. One case (1/11) preoperative HR⁃VWI classification was type Ⅲ occlusion which confirmed by intraoperative DSA really was typeⅡocclusion. A total of 10 patients (10/11) for recanalization, one failure case was HR⁃VWI classification typeⅢ⁃C. Perioperative complications occurred in 2 patients (2/11). Six and 7 patients improved in the first and third month after surgery, and 5 and 4 patients were stable, one patient developed in⁃stent restenosis in the sixth month after the operation. Conclusions Preoperative HR⁃VWI showed residual lumen in occlusion segment indicated higher success rate of recanalization and safety, and thrombosis in the residual lumen increased the risk of perioperative complications, but did not reduce the success rate and prognosis of recanalization.

DOI：10.3969/j.issn.1672⁃6731.2020.06.004