Recanalization of symptomatic chronic internal carotid artery occlusions by hybrid treatment
Weijian Fan1, Bo Li2, Xiaofeng Qu3
1Department of Vascular Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215003, PR China; Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, PR China.
Insights
Hybrid revascularization combining carotid endarterectomy and endovascular intervention shows promise for chronic internal carotid artery occlusion (ICAO). Successful treatment improved cognitive function and neurological scores, with occlusion duration influencing outcomes.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cerebrovascular Disease
Background:
- Chronic internal carotid artery occlusion (ICAO) poses a significant risk for stroke.
- Traditional treatment options for chronic ICAO have limitations.
- Hybrid revascularization offers a potential alternative approach.
Purpose of the Study:
- To evaluate the efficacy and safety of hybrid revascularization for symptomatic chronic ICAO.
- To compare outcomes between short-duration and long-duration ICAO groups.
- To identify factors influencing successful recanalization and perioperative results.
Main Methods:
- Retrospective analysis of 56 patients with symptomatic chronic ICAO treated with hybrid revascularization (December 2016-December 2018).
- Patients were divided into short (1-3 months) and long (>3 months) ICAO duration groups.
- Clinical and angiographic data were analyzed, including recanalization rates, complications, and functional outcomes.
Main Results:
- Recanalization failure occurred in 17.8% of the short-duration group versus 0% in the long-duration group.
- Perioperative complications were low, including thromboembolism (1.8%) and subarachnoid hemorrhage (3.6%).
- Successful recanalization significantly improved modified Rankin Scale, MMSE, and MoCA scores at 6 months. Long-duration ICAO required more stents.
Conclusions:
- Hybrid revascularization appears feasible and effective for symptomatic chronic complete ICAO.
- Occlusion duration and site are key indicators for successful recanalization and perioperative outcomes.
- Further research with larger cohorts is warranted to confirm these findings.
Objective:
To evaluate the efficacy and safety of hybrid revascularization by carotid endarterectomy and endovascular intervention in the treatment of chronic internal carotid artery occlusion (ICAO).
Methods:
We performed a retrospective analysis of patients who received hybrid treatment for symptomatic chronic ICAO between December 2016 and December 2018. Fifty-six patients with long-segment ICAO were enrolled and divided into the short duration (1-3 months) and long ICAO duration (>3 months) groups, and their clinical and angiographic data were analyzed.
Results:
The mean duration was 106.8 ± 36.1 days from the date of ICAO diagnosis to revascularization. Totally, 10 patients (17.8%, n = 56) in the short duration group while no patients in the long duration group failed recanalization (n = 7). Perioperative complications included intraoperative thromboembolism in 1 (1.8%) patient and subarachnoid hemorrhage in 2 (3.6%) patients. Early phase postoperative hypertension was noted in 11 (19.6%) patients and cervical hemorrhage in 1 (1.8%) patient. No severe neurological deficits occurred. Overall, the 6-month modified Rankin score, Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with successful recanalization significantly improved versus the baseline (P < 0.05). After successful recanalization, the long duration group demonstrated more stents for revascularization compared with the short duration group (P < 0.05). Five (10.8%) patients had recurrent transient ischemic attack, and 1 (2.2%) patient developed stroke in the successful revascularization group during 6 months of follow-up. ICA restenosis occurred in 5 (8.9%) patients and re-occlusion was noted in 1 (1.8%) patient.
Conclusions:
Hybrid operation may be feasible and effective for patients with symptomatic chronic complete ICAO according to our limited data. The original occlusion site from the carotid bifurcation and the duration of ICAO should be considered as independent indicators for successful recanalization as well as perioperative outcomes.
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