Zhang Sarah Y, Chung Hee Sahng, Dewar Brian, Fahed Robert, Shamy Michel, Shorr Risa, Dowlatshahi Dar
Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
PLoS One. 2025 Jul 11;20(7):e0326261. doi: 10.1371/journal.pone.0326261. eCollection 2025.
The spontaneous recanalization of an occluded extracranial internal carotid artery (ICA) is thought to be an uncommon etiology of ischemic stroke. However, a growing number of reports describe this phenomenon. We sought to perform a scoping review of the literature to assess the prevalence of spontaneous ICA recanalization and its timing in relation to occlusion, and any patterns in imaging and treatment.
MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2024 for studies that included adults with spontaneous recanalization or transient occlusion of the extracranial internal carotid artery. Two investigators independently screened the studies and extracted data around recanalization proportion, timepoints, imaging, and treatment. These results were described qualitatively, and descriptive statistics were calculated where appropriate.
Of 2807 studies screened, 53 met inclusion criteria, of which 17 were cohort studies and 36 were case studies, including a total of 818 patients. The proportion of recanalization was reported in 17 cohort studies for a median of 21.2% (IQR 9.2-37.5%). Amongst the studies which reported recanalization, 46.7% of those within the cohort studies recanalized within 6 months, whereas case studies reported that 66.7% of recanalizations occurred in that same timeframe. When reported, antiplatelet treatment was the most common medical treatment pre- and post-recanalization. Doppler imaging was used to identify recanalization in 67.9% of studies, and angiography was used in 54.7%. Twenty-one studies reported a revascularization procedure following spontaneous recanalization.
Spontaneous recanalization of an occluded extracranial carotid artery may occur, and possibly within 6 months after documented occlusion. However, clear data are lacking regarding a standard approach to imaging or treatment of patients with occluded carotid arteries.
闭塞性颅外颈内动脉（ICA）的自发再通被认为是缺血性卒中的一种不常见病因。然而，越来越多的报告描述了这一现象。我们旨在对文献进行范围综述，以评估ICA自发再通的发生率及其与闭塞相关的时间，以及成像和治疗方面的任何模式。
检索MEDLINE、Embase、Cochrane对照试验中心注册库和Web of Science，检索时间从建库至2024年3月，以查找纳入颅外颈内动脉自发再通或短暂闭塞的成人的研究。两名研究人员独立筛选研究，并提取有关再通比例、时间点、成像和治疗的数据。对这些结果进行定性描述，并在适当情况下计算描述性统计数据。
在筛选的2807项研究中，53项符合纳入标准，其中17项为队列研究，36项为病例研究，共818例患者。17项队列研究报告了再通比例，中位数为21.2%（四分位间距9.2 - 37.5%）。在报告了再通情况的研究中，队列研究中有46.7%在6个月内实现再通，而病例研究报告称，66.7%的再通发生在同一时间段内。在有报告的情况下，抗血小板治疗是再通前后最常见的药物治疗。67.9%的研究使用多普勒成像来识别再通，54.7%的研究使用血管造影。21项研究报告了自发再通后的血管重建手术。
闭塞性颅外颈动脉可能会自发再通，且可能在记录到闭塞后的6个月内发生。然而，关于闭塞性颈动脉患者成像或治疗的标准方法，目前缺乏明确的数据。
