Spontaneous recanalization of extracranial internal carotid occlusion: A systematic scoping review
Bibliographic record
Abstract
INTRODUCTION: The spontaneous recanalization of an occluded extracranial internal carotid artery (ICA) is thought to be an uncommon etiology of ischemic stroke. However, a growing number of reports describe this phenomenon. We sought to perform a scoping review of the literature to assess the prevalence of spontaneous ICA recanalization and its timing in relation to occlusion, and any patterns in imaging and treatment. METHODS: MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to March 2024 for studies that included adults with spontaneous recanalization or transient occlusion of the extracranial internal carotid artery. Two investigators independently screened the studies and extracted data around recanalization proportion, timepoints, imaging, and treatment. These results were described qualitatively, and descriptive statistics were calculated where appropriate. RESULTS: Of 2807 studies screened, 53 met inclusion criteria, of which 17 were cohort studies and 36 were case studies, including a total of 818 patients. The proportion of recanalization was reported in 17 cohort studies for a median of 21.2% (IQR 9.2-37.5%). Amongst the studies which reported recanalization, 46.7% of those within the cohort studies recanalized within 6 months, whereas case studies reported that 66.7% of recanalizations occurred in that same timeframe. When reported, antiplatelet treatment was the most common medical treatment pre- and post-recanalization. Doppler imaging was used to identify recanalization in 67.9% of studies, and angiography was used in 54.7%. Twenty-one studies reported a revascularization procedure following spontaneous recanalization. CONCLUSIONS: Spontaneous recanalization of an occluded extracranial carotid artery may occur, and possibly within 6 months after documented occlusion. However, clear data are lacking regarding a standard approach to imaging or treatment of patients with occluded carotid arteries.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.062 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.006 |
| Bibliometrics | 0.014 | 0.017 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".