Related Experiment Video
Updated: Oct 1, 2025
Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
Published on: November 22, 2024
Multimodal Recanalization for Subacute Symptomatic Internal Carotid Artery Occlusion Due to Atherosclerosis: Outcomes
Chuan Chen1, Cong Ling1, Lun Luo1
1Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China.
Insights
Multimodal recanalization safely restored blood flow in subacute internal carotid artery occlusion (ICAO), significantly improving cerebral blood perfusion and reducing stroke risk. This hybrid approach offers a promising solution for preventing recurrent strokes.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Radiology
Background:
- Subacute internal carotid artery occlusion (ICAO) increases the risk of ipsilateral recurrent stroke.
- Successful recanalization of ICAO can improve cerebral blood perfusion (CBP) and prevent stroke.
- Optimal treatment strategies for subacute ICAO remain under investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of multimodal recanalization techniques for subacute atherosclerotic ICAO.
- To assess the impact of recanalization on cerebral blood perfusion, stroke recurrence, and restenosis.
- To determine the long-term outcomes of patients treated with hybrid surgical procedures.
Main Methods:
- Retrospective analysis of 14 patients with subacute symptomatic atherosclerotic ICAO treated with hybrid surgical procedures.
- Procedures included carotid endarterectomy, embolectomy, thrombectomy, and angioplasty/stenting.
- Investigated recanalization rates, CBP improvement, stroke recurrence, and restenosis/reocclusion.
Main Results:
- 100% successful recanalization (Thrombolysis In Cerebral Ischemia grade 2 or 3) was achieved.
- Cerebral blood perfusion significantly improved, indicated by a lower ipsilateral-to-contralateral mean transit time ratio at 1-year follow-up (1.01 ± 0.05 vs. 1.26 ± 0.09, P < 0.0001).
- Low rates of restenosis (1 case) and no reocclusion were observed. Stroke recurrence was minimal (2 TIAs), and functional scores (mRS, NIHSS) improved significantly.
Conclusions:
- Multimodal recanalization in a hybrid operating theater is safe and effective for subacute atherosclerotic ICAO.
- High recanalization rates lead to improved CBP and reduced stroke risk.
- This approach offers significant benefits for patients with subacute ICAO.
Background:
Subacute internal carotid artery occlusion (ICAO) is associated with ipsilateral recurrent stroke, and successful recanalization of ICAO can improve cerebral blood perfusion (CBP) and prevent stroke. However, the optimal treatment remains controversial.
Methods:
We conducted a retrospective analysis of patients with subacute symptomatic ICAO due to atherosclerosis treated at our center. The hybrid surgical procedures included carotid endarterectomy, Fogarty balloon catheter embolectomy, aspiration thrombectomy, and percutaneous transluminal angioplasty/stenting. Recanalization rates, CBP improvement, stroke recurrence, and restenosis/reocclusion were investigated.
Results:
Fourteen symptomatic atherosclerotic ICAO patients (type A, 4; type C, 10; men, 11; women, 3; average age, 68.1 ± 7.9 years) in the subacute phase were treated with a multimodal recanalization technique. Symptoms included mild cerebral infarction, transient ischemic attack (TIA), and amaurosis fugax. The average onset-to-treatment time was 18.1 ± 4.8 days. The successful recanalization (thrombolysis in cerebral ischemia grade 2 or 3) rate was 100%. The ipsilateral-to-contralateral mean transit time ratio was significantly lower at the 1-year follow-up than preoperatively (1.01 ± 0.05 vs. 1.26 ± 0.09, P < 0.0001). There was one case of restenosis detected 1 year after surgery and no cases of reocclusion. During the 28.3 ± 10.0 months of follow-up, only two cases of TIA occurred. The average modified Rankin Scale score and National Institute of Health Stroke Scale score were significantly lower at the most recent follow-up than before recanalization (1.21 ± 0.89 vs. 1.86 ± 0.66, P = 0.0003; 1.36 ± 1.55 vs. 2.00 ± 1.88, P = 0.0066).
Conclusions:
Multimodal recanalization techniques performed in a hybrid operation theater can safely achieve high recanalization rates in atherosclerotic ICAO patients in the subacute phase, which can be beneficial for recovering CBP and preventing stroke.
