颈动脉慢性完全闭塞后再通的症状（英文）.pptVIP

Endpoints for intervention For PCI Death/MI Angina relief, LV function recovery, and TVR For ICA intervention Death/stroke Physiological and functional endpoints Neuro-cognitive evaluation Changes in perfusion imaging, such as perfusion CT, MRI, and PET Paul HL Kao 08 Conclusions Endovascular recanalization of ICAO is feasible and safe Future prospective studies with larger patient numbers evaluating soft endpoints are mandatory to establish the benefit and indication of recanalization of ICAO Paul HL Kao 08 It’s never too late to open a closed door, because the room behind may be full of surprises Definitions Atheromatous pseudo-occlusion (APO) String-like residual filling of ICA behind the “occlusion” Retrograde filling of the proximal so-called “occluded” ICA reaching the skull base Chronic total occulsion (CTO) The occlusion must be documented for at least 1 month TIMI 0 flow behind the occlusion with discontinuation of ICA lumen at least 5mm in length Established filling to the ipsilateral intracranial ICA via A-Com, P-Com, OA, meningeal, or other collaterals Paul HL Kao 07 Partial recovery of perfusion CT at 1 month Pre baseline Pre stress Post baseline Post stress Flow Paul HL Kao 07 Partial recovery of perfusion CT at 1 month Volume Pre baseline Post baseline Pre stress Post stress Paul HL Kao 07 Example of complete recovery Pre stress flow Post stress flow Paul HL Kao 08 Example of complete recovery Pre stress volume Post stress flow Paul HL Kao 08 Example of complete recovery Pre stress transit time Post stress transit time Paul HL Kao 08 Cerebral perfusion after ICAO Stage 0: CPP normal, CBF matched with resting metabolic demand, no regional variation in OEF Stage 1: CPP decreased, but CBF maintained by vasodilatation, CBV increased Stage 2: CPP further decreased beyond the capacity of auto-regulation, CBF decreased, regional OEF increased with declined brain function Paul HL Kao 08 Endovascular Recanalization of Symptomatic Chronic Total Occlusion of Cer