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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Hybrid surgery recanalization for high-level chronic internal carotid artery occlusion
Yuankun Cai1, Tingbao Zhang1, Lesheng Wang1
1Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Insights
Hybrid surgery, combining carotid endarterectomy and stenting, offers a safe and effective treatment for complex chronic internal carotid artery occlusion (CICAO). Recanalization success is linked to the occlusion
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Background:
- Chronic internal carotid artery occlusion (CICAO) presents treatment challenges, with endovascular methods showing inadequate success rates for complex cases.
- Complex CICAO requires advanced surgical approaches to restore blood flow and prevent neurological complications.
Purpose of the Study:
- To evaluate the safety and efficacy of a hybrid surgical approach (carotid endarterectomy plus carotid stenting) for complex CICAO.
- To identify factors influencing the success of hybrid surgery recanalization in complex CICAO patients.
Main Methods:
- Retrospective analysis of 22 patients with complex CICAO treated with hybrid surgery between December 2016 and December 2020.
- Review of clinical, imaging, and follow-up data, focusing on technical aspects and outcomes of hybrid recanalization.
Main Results:
- Hybrid surgery achieved an 86.4% recanalization success rate in 22 complex CICAO patients, with no postoperative deaths.
- Lesion classification and preoperative reverse ophthalmic artery blood flow were significantly associated with recanalization success (P=0.019 and P=0.038, respectively).
- Successful recanalization led to improved Karnofsky Performance Scale (KPS) scores (P < 0.001).
Conclusions:
- Hybrid surgery is a safe and effective option for complex CICAO, yielding high recanalization rates.
- The anatomical extent of the occlusion relative to the ophthalmic artery is a key factor in determining recanalization success.
Objective:
Although endovascular recanalization is considered a more effective treatment for chronic internal carotid artery occlusion (CICAO), the success rate of complex CICAO remains inadequate. We present hybrid surgery (carotid endarterectomy combined with carotid stenting) for complex CICAO and explore the influential factors and effects of hybrid surgery recanalization.
Methods:
We retrospectively analyzed the clinical, imaging, and follow-up data of 22 patients with complex CICAO treated by hybrid surgery at the Zhongnan Hospital of Wuhan University from December 2016 to December 2020. We also summarize the technical points related to hybrid surgery recanalization.
Results:
A total of 22 patients with complex CICAO underwent hybrid surgery recanalization. There were no postoperative deaths in all patients after hybrid surgery recanalization. Nineteen patients successfully underwent recanalization with a success rate of 86.4% and three cases with a failure rate of 13.6%. Patients were divided into success and failure groups. Significantly different radiographic classification of lesions was observed between the success group and the failure group (P = 0.019). The rates of CICAO with reverse ophthalmic artery blood flow in the internal carotid artery (ICA) preoperatively were 94.7% in the success group and 33.3% in the failure group (P = 0.038). Three cases of hybrid surgery recanalization failure were transferred for EC-IC bypass and had good neurological recovery. Postoperative average KPS scores of the 19 patients were improved compared to the preoperative ones (P < 0.001).
Conclusion:
Hybrid surgery for complex CICAO is safe and effective with a high recanalization rate. The recanalization rate is related to whether the occluded segment surpasses the ophthalmic artery.
