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Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion: A
Tao Sun1,2, Yiming He1,2, Fei Wang1,2
1Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China.
Insights
Hybrid surgery demonstrated a higher technical success rate for chronic internal carotid artery occlusion (CICAO) compared to endovascular intervention (EI). Both procedures showed similar safety and restenosis rates in patients with symptomatic CICAO.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Medicine
Background:
- Chronic internal carotid artery occlusion (CICAO) poses a risk for transient ischemic attack (TIA) and ischemic stroke.
- Carotid artery stenting (CAS) and hybrid surgery are established revascularization methods for CICAO.
- Evaluating the comparative efficacy and safety of these procedures is crucial for clinical decision-making.
Purpose of the Study:
- To compare the technical success, safety, and long-term outcomes of hybrid surgery versus endovascular intervention (EI) for symptomatic CICAO.
- To assess the recanalization rates and perioperative complications associated with each approach.
Main Methods:
- A retrospective, single-center study involving 44 patients undergoing hybrid surgery and 35 patients undergoing EI for symptomatic CICAO.
- Patients were classified into four groups (A-D) based on lesion characteristics.
- Data collected included clinical and angiographic details, technical success, perioperative complications, and follow-up events (stroke, restenosis).
Main Results:
- Hybrid surgery achieved a significantly higher technical success rate (84.1%) compared to EI (51.4%) (P=0.002).
- No significant differences were observed in the incidence of perioperative complications (15.9% vs. 17.1%, P=0.883) between the groups.
- Follow-up revealed no significant differences in stroke rates or restenosis between hybrid surgery and EI.
Conclusions:
- Hybrid surgery may offer an advantage in achieving successful recanalization for symptomatic CICAO.
- Both hybrid surgery and EI demonstrate comparable safety profiles and long-term restenosis rates.
Objective:
Chronic internal carotid artery occlusion (CICAO) can cause transient ischemic attack (TIA) and ischemic stroke. Carotid artery stenting (CAS) with embolic protection devices and hybrid surgery combining carotid endarterectomy and endovascular treatment are effective methods for carotid revascularization. The objective of this study was to evaluate and compare the effect and safety of the two surgical procedures.
Methods:
This was a single-center retrospective study. In this study, 44 patients who underwent hybrid surgery and 35 who underwent endovascular intervention (EI) at our center were enrolled consecutively between May 2016 and March 2022. All patients were classified into four groups (A-D), as described by Hasan et al. We recorded and analyzed clinical data, angiographic characteristics, technical success rate, perioperative complications, and follow-up data.
Results:
There was no significant difference in baseline characteristics between hybrid surgery group and EI group, except for plasma high density lipoproteins (HDL) levels (median [interquartile range]: hybrid surgery, 0.99 [0.88-1.18] vs. EI, 0.85 [0.78-0.98] mmol/L, P = 0.001). The technical success rate of hybrid surgery was higher than that of EI (37/44 [84.1%] vs. 18/35 [51.4%], P = 0.002; type A: 15/16 [93.8%] vs. 10/11 [90.9%], P = 1.000; type B: 9/10 [90.0%] vs. 5/7 [71.4%], P = 0.537; type C: 12/15 [80.0%] vs. 3/12 [25.0%], P = 0.004; type D: 1/3 [33.3%] vs. 0/5 [0%], P = 0.375). No significant difference was observed in the incidence of perioperative complications between the two procedures (hybrid surgery: 7/44 [15.9%] vs. EI: 6/35 [17.1%], P = 0.883). In addition, there were no significant differences in the rates of stroke and restenosis during follow-up.
Conclusions:
For patients with symptomatic CICAO, hybrid surgery may have an advantage over EI in successfully recanalizing occluded segments. There was no significant difference in safety and restenosis between hybrid surgery and EI.
