Ying-Hsien Chen1, Weng-San Leong2, Mao-Shin Lin3, Ching-Chang Huang1, Chi-Sheng Hung1, Hung-Yuan Li1, Kok-Kheng Chan4, Chih-Fan Yeh1, Ming-Jang Chiu5, Hsien-Li Kao6. 1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2. Pantai Hospital Ipoh, Malaysia. 3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan. 4. KPJ Penang Specialist Hospital, Penang, Malaysia. 5. Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hsienli_kao@yahoo.com.
Abstract
OBJECTIVES: This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO). BACKGROUND: Endovascular recanalization in patients with chronic CAO has been reported to be feasible, but technically challenging. METHODS: Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. We analyzed potential variables including epidemiology, symptomatology, angiographic morphology, and interventional techniques in relation to the technical success. RESULTS: The technical success rate was 61.6%. Multivariate analysis showed absence of prior neurologic event (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10 to 0.76), nontapered stump (OR: 0.18; 95% CI: 0.05 to 0.67), distal internal carotid artery (ICA) reconstitution via contralateral injection (OR: 0.19; 95% CI: 0.05 to 0.75), and distal ICA reconstitution at communicating or ophthalmic segments (OR:0.12; 95% CI: 0.04 to 0.36) to be independent factors associated with lower technical success. Point scores were assigned proportional to model coefficients, and technical success rates were >80% and <40% in patients with scores of ≤1 and ≥4, respectively. The c-indexes for this score system in predicting technical success was 0.820 (95% CI: 0.748 to 0.892; p < 0.001) with a sensitivity of 84.7% and a specificity of 67.9%. CONCLUSIONS: Absence of prior neurologic event, nontapered stump, distal ICA reconstitution via contralateral injection, and distal ICA reconstitution at communicating or ophthalmic segments were identified as independent negative predictors for technical success in endovascular recanalization for CAO.
OBJECTIVES: This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO). BACKGROUND: Endovascular recanalization in patients with chronic CAO has been reported to be feasible, but technically challenging. METHODS: Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. We analyzed potential variables including epidemiology, symptomatology, angiographic morphology, and interventional techniques in relation to the technical success. RESULTS: The technical success rate was 61.6%. Multivariate analysis showed absence of prior neurologic event (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10 to 0.76), nontapered stump (OR: 0.18; 95% CI: 0.05 to 0.67), distal internal carotid artery (ICA) reconstitution via contralateral injection (OR: 0.19; 95% CI: 0.05 to 0.75), and distal ICA reconstitution at communicating or ophthalmic segments (OR:0.12; 95% CI: 0.04 to 0.36) to be independent factors associated with lower technical success. Point scores were assigned proportional to model coefficients, and technical success rates were >80% and <40% in patients with scores of ≤1 and ≥4, respectively. The c-indexes for this score system in predicting technical success was 0.820 (95% CI: 0.748 to 0.892; p < 0.001) with a sensitivity of 84.7% and a specificity of 67.9%. CONCLUSIONS: Absence of prior neurologic event, nontapered stump, distal ICA reconstitution via contralateral injection, and distal ICA reconstitution at communicating or ophthalmic segments were identified as independent negative predictors for technical success in endovascular recanalization for CAO.
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