Multi-dimensional Evaluation System for Recanalization of Symptomatic Non-acute Carotid Artery Occlusion
Multi-dimensional Evaluation System for Recanalization of Symptomatic Non-acute Carotid Artery Occlusion
This is a multi-center, prospective, exploratory, observational, registration study on
 patients with symptomatic non-acute carotid artery occlusion to initially evaluate the safety
 and efficacy of endovascular treatment.
Although patients with symptomatic carotid occlusion were primarily treated with medication,
 the risk of 2-year stroke recurrence was as high as 22.7%. Ipsilateral stroke and hemodynamic
 decline are independent risk factors for stroke recurrence in patients with carotid artery
 occlusion. In addition, long-term cerebral hypoperfusion and decreased cerebrovascular
 reactivity in patients with carotid artery occlusion may lead to cognitive impairment.

 At present, the recanalization time window of anterior circulation large vessel occlusive
 stroke has been extended to 24 hours under certain evaluation approaches. In order to
 distinguish from the emergency treatment within 24 hours, patients with carotid artery
 occlusion over 24 hours are collectively referred as non-acute occlusion.

 With the maturity of endovascular technique and the advances of interventional devices,
 endovascular treatment has become a hotspot of clinical research in this field. Case reports
 have emerged and prospective studies suggest that recanalization of chronic carotid occlusion
 may improve the cognitive functions. However, the clinical benefit of endovascular treatment
 for symptomatic non-acute carotid artery occlusion remained controversial.

 The purpose of this study is to establish and verify the efficacy of a multi-dimensional
 evaluation system of endovascular treatment and recanalization of symptomatic non-acute
 carotid occlusion.
Inclusion Criteria:

 1. Sign the informed consent form

 2. Age: 18-80 years old;

 3. Occlusion of the common carotid artery or internal carotid artery (mTICI=0) confirmed
 by DSA

 4. The origin of occlusive segment is from the common carotid artery or the initial
 segment of the internal carotid artery to the petrous segment and above, and does not
 exceed the bifurcation of the internal carotid artery (C7 segment). The distal
 occluded vessels, including the middle cerebral artery, have no severe stenosis or
 occlusion confirmed by angiography

 5. Occlusion over 24 hours (confirmed by imaging or according to the patient's condition
 change)

 6. Ischemic stroke, TIA or progressive visual/cognition impairment associated with
 occlusion

 7. Distinguishable hypoperfusion area indicated by CT perfusion (CBF decrease)

 Exclusion Criteria:

 1. Target vessel occlusion caused by radiotherapy, vasculitis, moyamoya disease.

 2. Any history of intracranial hemorrhage (imaging confirmed or medical record
 confirmation, except for SWI recorded micro-bleeding) within 3 months.

 3. Large core infarction history or index stroke caused by large core infarction (infarct
 volume >70ml, or exceeding the MCA territory >1/3, or middle cerebral structural
 shifting)

 4. Disabling before index event (mRS>3)

 5. History of serious allergy to contrast media (excluding rash), allergic to heparin,
 aspirin, clopidogrel, statins, metals and anesthetics, or intolerant to general
 anesthesia

 6. Target vessel tortuous or complex vasculature which may cause procedural difficulty

 7. Combined with untreated severe coronary artery stenosis or occlusion, untreated
 intracranial aneurysms, intracranial tumors (other than meningiomas) or any
 intracranial vascular malformations

 8. Gastrointestinal or urinary bleeding, AMI, craniocerebral trauma, major surgery within
 30 days

 9. Active bleeding constitution or coagulation disease, platelet count < 50 × 10^9 / L

 10. Uncontrolled hypertension (systolic blood pressure > 185mmhg), GLU<2.8 mmol/L,
 GLU>18mmol/L

 11. Severe cardiac insufficiency, severe liver injury (AST or ALT more than 3 times of
 normal value), severe renal insufficiency (creatinine > 177 μ mol / L)， and other
 late-stage disease

 12. Known to have dementia or mental illness, and unable to complete neurological and
 cognitive assessment

 13. Expected survival time<1 year

 14. Pregnant or lactating female

 15. Included in other studies and in conflict with this study

 16. Other special circumstances not suitable for endovascular surgery by consideration of
 neuro-physician, neurosurgeon, or neurointerventional