Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania.
J Neurointerv Surg. 2023 Sep;15(9):851-857. doi: 10.1136/jnis-2022-019219. Epub 2022 Sep 8.
The optimal management of chronic total carotid artery occlusion (CTO) is still debated. Endovascular treatment is being increasingly used with heterogeneous technical and clinical results.
Patients with CTO treated with modern endovascular approaches during the past several years (January 2018-December 2021) were retrospectively reviewed.
Twenty patients, with a mean age of 63.7 years, were treated during the study period. Indications for treatment were recurrent stroke in 12 (60%), hemodynamic impairment in 4 (20%), and progressive stroke in 4 (20%) patients. In 6 (30%) patients, the occlusion was limited to the cervical portion, in 5 (25%) to the petrous segment, and in 9 (45%) to the cavernous segment. Technical treatment success was achieved in 80% of cases. In patients with successful recanalization, median pretreatment hypoperfusion volumes dropped from 126 mL (25-75 IQR, 33-224 mL) to 0 mL (25-75 IQR, 0-31.5 mL). Symptomatic procedure-related complications were 30% and permanent procedure-related morbidity-mortality was 5%. Early stent occlusion occurred in 5 (25%) cases. Two cases were asymptomatic and were not retreated, 3 cases presented transient symptoms of which two were successfully recanalized. Stent occlusion was not associated with permanent symptoms. In successfully recanalized patients no intraprocedural emboli were observed.
In the modern endovascular era, revascularization of CTO is a feasible procedure in most cases, and it may be offered in selected patients. However, the high re-occlusion rate is still a limitation of the technique, underlining the need for more research on the technical procedural and periprocedural management.
慢性全颈动脉闭塞（CTO）的最佳治疗方法仍存在争议。血管内治疗的应用越来越广泛，但其技术和临床结果存在差异。
回顾性分析了过去几年（2018 年 1 月至 2021 年 12 月）采用现代血管内方法治疗的 CTO 患者。
研究期间共治疗了 20 例平均年龄为 63.7 岁的患者。12 例（60%）患者因复发性卒中、4 例（20%）因血流动力学障碍、4 例（20%）因进展性卒中而接受治疗。6 例（30%）患者闭塞局限于颈部，5 例（25%）局限于岩骨段，9 例（45%）局限于海绵窦段。技术治疗成功率为 80%。在成功再通的患者中，治疗前低灌注体积中位数从 126ml（25-75 IQR，33-224ml）降至 0ml（25-75 IQR，0-31.5ml）。症状性手术相关并发症发生率为 30%，永久性手术相关发病率和死亡率为 5%。5 例（25%）发生早期支架闭塞。2 例无症状且未进行再治疗，3 例出现短暂症状，其中 2 例再通成功。支架闭塞与永久性症状无关。在成功再通的患者中，未观察到术中栓子。
在现代血管内治疗时代，CTO 再通术在大多数情况下是可行的，可选择性地应用于部分患者。然而，再闭塞率仍然是该技术的一个局限性，这凸显了需要对技术操作和围手术期管理进行更多的研究。
