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KMID : 1142120150170030336
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Journal of Stroke
2015 Volume.17 No. 3 p.336 ~ p.343
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Endovascular Management of Long-Segmental Petrocavernous Internal Carotid Artery (Carotid S) Occlusion
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Park Soon-Chan
Park Eun-Suk
Kwak Jae-Hyuk
Lee Dong-Geun
Suh Dae-Chul
Kwon Sun-U.
Lee Deok-Hee
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Abstract
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Background and Purpose: Long-segmental thrombotic occlusion of the distal internal carotid artery (ICA) sparing the cervical segment proximally and the supraclinoid segment distally, which could be termed ’Carotid S occlusion’, has an unusual clinical presentation. However, endovascular management of this lesion is challenging. The purpose of our study is to report our endovascular treatment clinical experience of the disease.
Methods: From March 2008 to June 2013, we could identify 14 patients (average age: 62.1, median age: 62, range: 50-79) with ‘Carotid S occlusion’, who underwent endovascular recanalization procedures. Patient’s clinical presentations were collected and the imaging findings also analyzed. The technical success rate, 24-hour and follow-up imaging outcome, and the clinical outcome using the 90-day mRS (modified Rankin scale) score were evaluated.
Results: Patients presented with gradually progressing (n = 8), fluctuating (n = 3), transient ischemic attack (n = 2) and stationary (n = 1) symptoms. DWI showed internal and external border-zone lesions in six patients, only internal ICA border-zone lesions in three patients, and only external border-zone lesions in two patients. Underlying distal ICA stenosis was noted in 12 patients. The technical success rate was 92.8% (13/14). Luminal patency was noted in all patients (100%) after 24 hours and in nine of 10 (90%) on long-term follow-up (median: 6.5, average: 15.1, range: 1-39 months). A 90-day, good functional outcome (mRS ≤ 2) was noted in 13 of 14 patients (92.8%).
Conclusions: ‘Carotid S occlusion’ usually presented with border-zone infarction and endovascular management of the lesions was feasible. A relatively successful clinical outcome could be achieved after successful revascularization.
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KEYWORD
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Stroke, Carotid artery, internal, Atherosclerosis, Angioplasty, balloon, Stents
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