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

doi:10.3969/j.issn.1672-6731.2020.06.005

Abstract

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 occlusion to 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 103 cases, there were 33 patients who failed in recanalization, the failure rate was 32.04%. One case (0.97%) occurred subarachnoid hemorrhage which induced severe headache during operation. Logistic regression analysis showed that the stump of the 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 occluded ICA are the key in judging the difficulty of recanalization.

Key words: Arterial occlusive diseases, Carotid artery,internal, Angioplasty, Risk factors, Logistic models

摘要：

目的分析慢性颈内动脉闭塞血管再通失败的原因及其影响因素。方法纳入2012年12月至2019年12月接受血管再通治疗的103例慢性颈内动脉闭塞患者，分析其血管再通失败原因（性别、年龄、基础疾病、闭塞至血管再通治疗时间、闭塞近端残端形态和远端反流位置），单因素和多因素Logistic回归分析筛查血管再通失败相关影响因素。结果 103例患者中33例（32.04%）血管再通失败，1例（0.97%）术中发生蛛网膜下腔出血致严重头痛。Logistic回归分析显示，闭塞近端残端形态呈非尖头型（OR=3.037，95% CI：1.245~7.406；P=0.015）和闭塞远端反流位置位于海绵窦段以上（C4~C6段；OR=3.118，95% CI：1.206~8.061，P=0.019）是慢性颈内动脉闭塞血管再通失败的危险因素。进一步分析血管再通失败原因，27例（81.82%）术中微导丝无法通过闭塞段，主要发生于C4~C5段（14例，42.42%）和C1段（11例，33.33%）；余6例（18.18%）术中发生动脉夹层，主要发生于C4~C5段（5例，15.15%）。结论慢性颈内动脉闭塞血管再通治疗相对安全、可行，闭塞近端残端形态和远端反流位置是预测血管再通成败的关键因素。

关键词: 动脉闭塞性疾病, 颈内动脉, 血管成形术, 危险因素, Logistic模型

HE Zi-jun, MO Da-peng, DENG Yi-ming, HUO Xiao-chuan, MA Ning, GAO Feng, MIAO Zhong-rong. Analysis of failure in endovascular recanalization of chronic internal carotid artery occlusion[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(6): 489-495.

何子骏, 莫大鹏, 邓一鸣, 霍晓川, 马宁, 高峰, 缪中荣. 慢性颈内动脉闭塞血管再通失败原因分析[J]. 中国现代神经疾病杂志, 2020, 20(6): 489-495.

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