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Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges
Răzvan Alexandru Radu1,2, Federico Cagnazzo3, Imad Derraz3
1Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France raduarazvan@yahoo.com.
Insights
Endovascular treatment for chronic total carotid artery occlusion (CTO) is feasible in selected patients, but high re-occlusion rates necessitate further research into procedural techniques.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Therapy
Background:
- Optimal management for chronic total carotid artery occlusion (CTO) remains debated.
- Endovascular treatment for CTO is increasingly utilized, yet yields varied results.
Purpose of the Study:
- To evaluate the feasibility and outcomes of modern endovascular approaches for treating chronic total carotid artery occlusion (CTO).
Main Methods:
- Retrospective review of patients with CTO treated with endovascular methods between January 2018 and December 2021.
- Analysis of technical success, complication rates, and long-term outcomes.
Main Results:
- Technical success was achieved in 80% of cases, with significant reduction in hypoperfusion volumes post-recanalization.
- Symptomatic and permanent procedure-related morbidity-mortality were 30% and 5%, respectively.
- Early stent re-occlusion occurred in 25% of cases, but was not associated with permanent symptoms.
Conclusions:
- Revascularization of CTO via endovascular means is feasible for selected patients in the current era.
- High rates of re-occlusion remain a significant limitation, highlighting the need for improved procedural and periprocedural management strategies.
Background:
The optimal management of chronic total carotid artery occlusion (CTO) is still debated. Endovascular treatment is being increasingly used with heterogeneous technical and clinical results.
Methods:
Patients with CTO treated with modern endovascular approaches during the past several years (January 2018-December 2021) were retrospectively reviewed.
Results:
Twenty patients, with a mean age of 63.7 years, were treated during the study period. Indications for treatment were recurrent stroke in 12 (60%), hemodynamic impairment in 4 (20%), and progressive stroke in 4 (20%) patients. In 6 (30%) patients, the occlusion was limited to the cervical portion, in 5 (25%) to the petrous segment, and in 9 (45%) to the cavernous segment. Technical treatment success was achieved in 80% of cases. In patients with successful recanalization, median pretreatment hypoperfusion volumes dropped from 126 mL (25-75 IQR, 33-224 mL) to 0 mL (25-75 IQR, 0-31.5 mL). Symptomatic procedure-related complications were 30% and permanent procedure-related morbidity-mortality was 5%. Early stent occlusion occurred in 5 (25%) cases. Two cases were asymptomatic and were not retreated, 3 cases presented transient symptoms of which two were successfully recanalized. Stent occlusion was not associated with permanent symptoms. In successfully recanalized patients no intraprocedural emboli were observed.
Conclusions:
In the modern endovascular era, revascularization of CTO is a feasible procedure in most cases, and it may be offered in selected patients. However, the high re-occlusion rate is still a limitation of the technique, underlining the need for more research on the technical procedural and periprocedural management.
