Department of Neurosurgery, University of South Florida, Tampa, FL, USA.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Interv Neuroradiol. 2023 Aug;29(4):351-357. doi: 10.1177/15910199221090724. Epub 2022 Mar 24.
Carotid artery stenting is associated with a higher rate of stroke compared to carotid endarterectomy (CEA). This is likely due to procedural emboli resulting from plaque disruption. The transcarotid artery revascularization (TCAR) method aims to reduce the stroke rate by flow-reversal. TCAR, which has yet to be utilized for intracranial atherosclerotic disease (ICAD), may be particularly valuable given the lack of surgical treatment options for intracranial arterial stenosis.
Presented here are five cases of angioplasty or stenting that demonstrate the feasibility of TCAR for intracranial Internal Carotid Artery (ICA) stenosis treatment.
Five cases were reviewed retrospectively and summarized using PROCESS and CARE guidelines.
All patients who underwent intervention between the petrous and ophthalmic segment of the ICA had no new neurologic deficit nor detected embolic stroke. One patient experienced an asymptomatic 5 mm hemorrhage on postoperative routine Computed Tomography (CT) head imaging.
This highlights a new method for treating intracranial ICA stenosis with a potentially reduced stroke risk. Given the historically higher stroke rates for cervical ICA stenting compared to carotid artery endarterectomy, this method may improve the previously higher stroke rates in endovascular carotid artery treatment, compared to CEA. Although this series is small, it illustrates a novel use for a rising technique that should be further evaluated in a larger study to validate its efficacy as a new treatment modality for surgically inaccessible intracranial disease.
与颈动脉内膜切除术（CEA）相比，颈动脉支架置入术（CAS）后发生中风的风险更高。这可能是由于斑块破裂导致的操作过程中产生的栓子。经颈动脉血管重建术（TCAR）旨在通过血流反转来降低中风率。TCAR 尚未用于颅内动脉粥样硬化性疾病（ICAD），但鉴于颅内动脉狭窄缺乏手术治疗选择，它可能特别有价值。
本文介绍了 5 例血管成形术或支架置入术，证明了 TCAR 治疗颅内颈内动脉（ICA）狭窄的可行性。
回顾性分析了 5 例患者，采用 PROCESS 和 CARE 指南进行总结。
所有在 ICA 岩骨段和眼段之间进行介入治疗的患者均无新发神经功能缺损或检测到栓塞性中风。1 例患者在术后常规计算机断层扫描（CT）头部成像上发现无症状性 5mm 出血。
这突出了一种治疗颅内 ICA 狭窄的新方法，可能降低中风风险。鉴于颈内动脉支架置入术的中风发生率 historically 高于 CEA，与 CEA 相比，这种方法可能会降低血管内颈动脉治疗的先前更高的中风率。尽管本系列病例数量较少，但它说明了一种新兴技术的新用途，应该在更大的研究中进一步评估，以验证其作为一种新的治疗方法治疗手术不可及的颅内疾病的有效性。
