Endovascular recanalization of subacute or chronic symptomatic occlusion of the internal carotid artery ophthalmic segment

Objective

To investigate the safety and effect of endovascular recanalization for subacute or chronic occlusion of the internal carotid artery (ICA) ophthalmic segment and risk factors for the prognosis.

Materials and methods

135 patients with subacute or chronic occlusion of the ICA ophthalmic segment were retrospectively enrolled to undergo endovascular recanalization, with the clinical, imaging and follow-up data being analyzed.

Results

Among 135 patients with ICA ophthalmic segment occlusion, hypertension was presented in 72 (53.3 %) patients, diabetes mellitus in 44 (32.6 %), coronary heart disease in 12 (8.9 %), smoking in 51 (37.8 %), and alcohol abuse in 38 (28.1 %). Endovascular recanalization was performed in all patients, and recanalization was successful in 130 (96.3 %). Five patients (3.7 %) were not recanalized because of intraprocedural complications. Periprocedural complications occurred in 16 patients, resulting in a total complication rate of 11.9 %. The mRS (modified Rankin Scale score) was 1.45 ± 0.03 after recanalization, significantly (P < 0.001) better than that (2.25 ± 0.12) before recanalization. The NIHSS (National Institute of Health Stroke Scale) was 11.91 ± 0.67, significantly (P < 0.0001) better than that (18.45 ± 1.33) before recanalization. Eighty-nine (65.9 %) patients underwent angiography at follow-up 6–86 (mean 48) months after recanalization, which demonstrated good prognosis in 72 (80.9 %) patients and poor prognosis in the other 17 (19.1 %) with instent restenosis > 50 %. Telephone follow-up was conducted in 46 (34.1 %) patients 6–38 (mean 27) months after recanalization, which revealed good prognosis in 38 (82.6 %) patients and poor prognosis in 8 (17.4 %). In total, good prognosis was present in 110 (81.5 %) patients while poor prognosis in 25 (18.5 %). In angiographic follow-up, instent restenosis > 50 % was present in nine (10.1 %) patients. Univariate analysis showed age (OR = 1.82), hypertension (OR = 2.38), diabetes mellitus (OR = 1.84), and alcohol abuse (OR = 1.49) were significant (P < 0.05) risk factors, whereas multivariate analysis demonstrated that only hypertension (OR = 1.54) and diabetes mellitus (OR = 2.67) were significant (P < 0.05) independent risk factors to affect the prognosis of recanalization.

Conclusion

Subacute or chronic occlusion of the internal carotid artery ophthalmic segment can be safely and efficiently recanalized using endovascular skills, and hypertension and diabetes mellitus are the independent risk factors for the prognosis of endovascular recanalization.