I. Petrov, L. Grozdinski, I. Tasheva, B. Zehirov
Department of Cardiology and Angiology, City Clinic – Sofia, Bulgaria

Objective: Occluded and nearly occluded internal carotid arteries have lower risk of subsequent stroke, because antegrade flow no longer exists. Still, cervical ICA occlusion is associated with an annual risk of 6 to 20% of ipsilateral recurrent stroke. Extracranial-to-intracranial (EC-IC) artery bypass failed to reduce the risk of ischemic stroke. Occlusion/ near occlusion of internal carotid arteries has long been definitive contraindication for endovascular treatment but several small series showed that endovascular recanalization and stenting of occluded and near occluded carotids is feasible. Data are still controversial. To analyze and present the results of percutaneous recanalization and stenting of total and subtotal carotid stenoses for a 10 years period.

Material and Methods: Between 2002 and 2012 51 occluded and subtotally stenosed carotid arteries were stented. They represent 8 % of the total 632 CAS procedures in this period. Five (9.8%) of them were chronic carotid occlusions and 46 (90.2%) subtotal carotid stenoses. In all but one distal filter protection was used.

Results: A successful stenting was achieved in 50 cases (98%). There early periprocedural complications were: one ipsilateral stroke (1.9%), one transient ischemic attack, one myocardial infarction (1.9%), one death (1.9%) and one local bleeding. The combined incidence of stroke/death/MI was 3.9%. The results were not significantly different compared to the “non-occlusion” group. In the follow-up period were found 1 stroke, 1 death and 1 in-stent restenosis.

Discussion: The decision to revascularize a patient with a carotid string sign remains complex and should be made after careful deliberation. Most of these patients, particularly asymptomatic patients, do not require revascularization. Therapy should be tailored to the individual patient. Recurrent or crescendo symptoms warrant treatment. Carotid occlusion and near occlusion is an under-recognized condition, and CAS seems to be beneficial when performed by an experienced neurointerventional team.

Key words: carotid occlusion, carotid stenting, distal protection.