Department of Neurological Surgery, Wakayama Rosai Hospital, Wakayama, Japan.
J Neurosurg. 2010 Mar;112(3):563-71. doi: 10.3171/2009.6.JNS09125.
The efficacy and pitfalls of endovascular recanalization were evaluated in cases of internal carotid artery (ICA) occlusion in the subacute to chronic stage.
Fourteen cases (15 lesions) of symptomatic ICA occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. The Parodi embolic protection system was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal ICA to the common carotid artery.
Recanalization of the occluded ICA was possible in 14 of 15 lesions. The occlusion points were 10 cervical ICAs and 4 petrous/cavernous ICAs in successfully recanalized cases. Ischemic symptoms disappeared completely after the treatment, and new ischemic symptoms did not appear related to the treated lesion. Single photon emission computed tomography findings demonstrated the improvement of hemodynamic compromise in all cases. One case showed right middle cerebral artery branch occlusion during the procedure, but this patient's neurological symptoms were stable due to preexisting hemiparesis. Endovascular recanalization was possible and effective in improving hemodynamic compromise. However, there are still several problems with this technique, such as hyperperfusion syndrome after recanalization, cerebral embolism during treatment, durability after treatment, and identification of the occlusion point before treatment.
Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise or refractoriness to antiplatelet therapy, even in the subacute to chronic stage of the illness.
评估血管内再通术治疗颈内动脉（ICA）闭塞亚急性期至慢性期的疗效和潜在问题。
采用血管内技术对 14 例（15 处病变）有症状的 ICA 闭塞合并血流动力学障碍或复发性症状的患者在亚急性期至慢性期进行治疗。在再通过程中使用 Parodi 栓塞保护系统，通过将血流从远端 ICA 逆转到颈总动脉来防止栓塞性卒中。
15 处病变中有 14 处再通成功。成功再通的病例中，闭塞部位为 10 个颈内段 ICA 和 4 个岩骨/海绵窦段 ICA。治疗后缺血症状完全消失，且未出现与治疗病变相关的新缺血症状。单光子发射计算机断层扫描结果显示所有病例的血流动力学障碍均得到改善。1 例患者在治疗过程中出现右侧大脑中动脉分支闭塞，但由于存在偏瘫，该患者的神经症状稳定。血管内再通可改善血流动力学障碍，是一种有效的治疗方法。然而，该技术仍存在一些问题，如再通后的过度灌注综合征、治疗过程中的脑栓塞、治疗后的持久性以及治疗前的闭塞部位识别。
即使在疾病的亚急性期至慢性期，使用栓塞保护装置的血管内再通术也可作为有血流动力学障碍或对抗血小板治疗无反应的症状性 ICA 闭塞的替代治疗方法。
