To determine the incidence of recanalization of the occluded internal carotid artery (ICA) and establish its natural history.
Methods:
Patients with duplex-confirmed ICA occlusions were identified, and a subgroup offered repeat scanning. The antemortem condition and cause of death of patients who died were recorded.
Results:
Of 153 patients identified, 77 underwent follow-up at a median of 35 months (interquartile range [IQR]: 14-61).In all, 8 (10.3%) demonstrated recanalization at a median of 53 months (IQR: 35-114). Of 8, 7 underwent carotid endarterectomy with histopathological confirmation of recanalization. Of the 153 patients, 45 (29%) had further neurological events, and 38 (25%) were within the territory of the occluded ICA. In all, 76 patients died, and of the 53 with a confirmed cause of death, 12 (23%) were attributed to a cerebrovascular accident corresponding to the territory of the occluded artery.
Conclusion:
Recanalization of ICA occlusion is common and leads to significant neurological events. Duplex ultrasound follow-up appears mandatory.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med1991; 325: 445–453.
2.
European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet1998; 351: 1379–1387.
3.
BarnettHJTaylorDWEliasziwMFoxAJFergusonGGHaynesRBBenefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med1998; 339: 1415–1425.
4.
RothwellPMGutnikovSAWarlowCP. Reanalysis of the final results of the European Carotid Surgery trial. Stroke2003; 34: 514–523.
5.
RothwellPMEliasziwMGutkinovSAFoxAJTaylorDWMaybergMRAnalysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet2003; 361: 107–116.
6.
HallidayAMansfieldAMarroJPetoCPetoRPotterJPrevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet2004; 364: 1491–1502.
7.
HallidayAHarrisonMHayterEKongXMansfieldA, Marro J, et al. 10-year stroke prevention after successful carotid endarterectomy for symptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet2010; 376: 1074–1084.
SatianiBBurnsJVaskoJS. Surgical and nonsurgical treatment of total carotid artery occlusion. Am J Surg1985; 149: 362–367.
10.
HennericiMDHulsmonerH-BRautenbergWHefterH. Spontaneous history of asymptomatic internal carotid artery occlusion. Stroke1986; 17: 718–722.
11.
FaughtWEvan BemmelenPSMattosMAHodgsonKJBarkmeierLDRamseyDESumnerDS. Presentation and natural history of internal carotid artery occlusion. J Vasc Surg1993; 18: 512–524.
12.
GomensoroJB.Joint study of extracranial arterial occlusion: VIII. Clinical-radiographic correlation of carotid bifurcation lesions in 177 patients with transient cerebral ischaemic attacks. JAMA1973; 224: 985–991.
GrubbRLDerdeynCPFritschSMCarpenterDAYundtKDVideenTOImportance of haemodynamic factors in prognosis of symptomatic carotid occlusion. JAMA1998; 280: 1055–1060.
15.
CheemaSClarke-MoloneyMKavanaghEGBurkePEGracePA. Natural history and clinical outcome of patients with documented carotid artery occlusion. Ir J Med Sci2007; 176: 289–291.
16.
GohelMSHamishMHarri JenkinsIDaviesAH. Symptomatic late recanalization of an occluded internal carotid artery: a case report and review of the literature. Vasc Endovascular Surg2008; 42: 486–488.
17.
MaticPIlijevskiNRadakSKolarJRadakD. Recanalization of chronic carotid occlusion: case report and review of the literature. Vascular2009; 17: 281–283.
18.
BuslovichSHinesGL. Spontaneous recanalization of chronic internal carotid artery occlusions: report of 3 cases. Vasc Endovascular Surg2011; 45: 93–97.
19.
CamporeseGLabropoulosNVerlatoFBernardiERagazziRSalmistraroGBenign outcome of objectively proven spontaneous recanalization of internal carotid artery occlusion. J Vasc Surg2011; 53: 323–329.
20.
FieldsWSLemakNA. Joint study of extracranial arterial occlusion. X. Internal carotid artery occlusion. JAMA1997; 235: 2734–2738.
EC/IC Bypass Study Group. Failure of extracranial–ntracranial arterial bypass to reduce the risk of ischaemic stroke. Results of an international randomised trial. N Eng J Med1985; 313: 1191–1200.
23.
LehrerGM. Arteriographic demonstration of collateral circulation in cerebrovascular disease. Neuroradiology1958; 8: 27–32.
Abu RahmaAFPollackJARobinsonPAMullinsD. The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion. Am J Surg1997; 174: 185–187.
28.
HoshinoHTakagiMTakeuchiIAkutsuTTakagiYShinichirouE. Recanalization of intracranial carotid occlusion detected by duplex carotid sonography. Stroke1989; 20: 680–686.
29.
MevesSHMuhsAFederleinJButtnerTPrzuntekKPostertT. Recanalization of acute symptomatic occlusions of the internal carotid artery. J Neurol2002; 249: 188–192.
Di CarloALaunerLJBretelerMMFratiglioniLLoboAMartinez-LageJ. Frequency of stroke in Europe: A collaborative study of population-based cohorts. ILSA Working Group and the Neurologic Diseases in the Elderly Research Group. Italian Longitudinal Study on Aging. Neurology2000; 54 (Suppl 5): S28–33.
