Predictors for Successful Endovascular Intervention in Chronic Carotid Artery Total Occlusion

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• 作者：Ying-Hsien Chen ; MD^a ; Weng-San Leong ; MD^b ; Mao-Shin Lin ; MD^a ; ^c ; Ching-Chang Huang ; MD^a ; Chi-Sheng Hung ; MD^a ; Hung-Yuan Li ; MD^a ; Kok-Kheng Chan ; MD^d ; Chih-Fan Yeh ; MD^a ; Ming-Jang Chiu ; MD ; PhD^e ; Hsien-Li Kao ; MD^a ; ^{hsienli_kao@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：carotid artery ; chronic total occlusion ; endovascular stenting ; predictors ; scoring system
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：12 September 2016
• 年：2016
• 卷：9
• 期：17
• 页码：1825-1832
• 全文大小：648 K

文摘

This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO).

Background

Endovascular recanalization in patients with chronic CAO has been reported to be feasible, but technically challenging.

Methods

Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. We analyzed potential variables including epidemiology, symptomatology, angiographic morphology, and interventional techniques in relation to the technical success.

Results

The technical success rate was 61.6%. Multivariate analysis showed absence of prior neurologic event (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.10 to 0.76), nontapered stump (OR: 0.18; 95% CI: 0.05 to 0.67), distal internal carotid artery (ICA) reconstitution via contralateral injection (OR: 0.19; 95% CI: 0.05 to 0.75), and distal ICA reconstitution at communicating or ophthalmic segments (OR:0.12; 95% CI: 0.04 to 0.36) to be independent factors associated with lower technical success. Point scores were assigned proportional to model coefficients, and technical success rates were >80% and <40% in patients with scores of ≤1 and ≥4, respectively. The c-indexes for this score system in predicting technical success was 0.820 (95% CI: 0.748 to 0.892; p < 0.001) with a sensitivity of 84.7% and a specificity of 67.9%.

Conclusions

Absence of prior neurologic event, nontapered stump, distal ICA reconstitution via contralateral injection, and distal ICA reconstitution at communicating or ophthalmic segments were identified as independent negative predictors for technical success in endovascular recanalization for CAO.