| Objective: Chronic internal carotid artery occlusion(CICAO)is one of the main causes of ischemic stroke.It is generally believed that the occlusion time of chronic internal carotid artery occlusion is more than 4 weeks which has an incidence rate of approximately 6 per 100,000 individuals.About 5.9% of the patients have ipsilateral ischemic stroke per year.Ischemic events still occur in 6% to 20% of CICAO patients each year after receiving standard drug treatment,and the risk of ischemic stroke is higher in patients with known hemodynamic damage at the distal end of the occlusive artery(about 30% per year).Therefore,it is of great clinical significance to find the optimal treatment for CICAO.The treatment of CICAO includes conservative treatments,CEA,endovascular therapy,hybrid surgery and so on.Endovascular therapy has the advantages of less trauma,high success rate and good safety,but there are also some technical limitations such as the fiber cap is difficult to break through;the guide wire is hard to pass through the twisted and angled occlusive segment and is easy to enter the false cavity;the occlusion rate of the bare metal stent commonly used in nerve intervention is high,and the solutions to the above problems need to be explored urgently.The mechanism of CICAO is similar to that of Chronic Total Occlusion(CTO),which is the final outcome of the development of atherosclerotic stenosis.Therefore,coronary CTO percutaneous coronary intervention(PCI)therapy can provide important reference experience for endovascular treatment of CICAO.The PCI treatment of CTO was started earlier and there is a more mature treatment process at present.Originally designed for coronary CTO PCI microwire,double-lumen microcatheter,drug-eluting stent(DES)and so on,as well as a variety of chronic occlusion assisted patency technology in the application value and technical advantages of CICAO need to be explored.Objective: The purpose of this study was to explore the application value of coronary CTO microwire,DES and auxiliary patency technique in endovascular treatment of CICAO,and to analyze the factors affecting vascular recanalization rate and longterm stent reocclusion rate.Methods: The clinical data of patients with CICAO who received endovascular therapy in the neurointerventional ward of Dalian Municipal Central hospital from January 2019 to December 2020 was etrospective analysis.According to the classification criteria proposed by DSA and Lee,patients were divided into two groups: occlusion involving the clinoid segment of the internal carotid artery(group A)and below the clinoid segment of the internal carotid artery or the common carotid artery(group B).The vascular recanalization,perioperative complications and instent occlusion within 1 year after operation were evaluated,and the results were compared with those of Lee et al.Results: A total of 37 patients who met the criteria were selected and all of them received endovascular interventional therapy.Group A(n = 19)and group B(n = 18).Successful revascularization was achieved in all cases in group A(19/19,100%)and B(18/18,100%);Perioperative complications occurred in group A(3/19,15.8%)and group B(2/18,11.1%);The re-occlusion rate of stents within 1 year after operation was(1/19,5.3%)in group A and(1/18,5.6%)in group B.Compared with the results of Lee et al,the recanalization rate of vascular increased significantly in group A and B in this study,and the reocclusion rate of stents decreased significantly within 1 year after operation,and the difference was statistically significant,but there was no significant difference in the incidence of perioperative complications.Conclusion: The use of coronary microwire and CTO recanalization technique in the revascularization of CICAO is safe and effective,which is beneficial to the recanalization of chronic internal carotid artery occlusion,and the application of drugeluting stent can reduce the rate of long-term reocclusion after operation.This method is worthy of further exploration in the treatment of CICAO. |
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