A proposed modern standardized technical approach for symptomatic chronic carotid total occlusion management
Răzvan Alexandru Radu1,2,3, Federico Cagnazzo1, Adrien Ter Schiphorst4
1Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Insights
Endovascular treatment for chronic carotid total occlusion (CCTO) shows promise for preventing recurrent ischemic stroke. Further standardization is needed before widespread clinical trial testing.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Chronic carotid total occlusion (CCTO) is a significant cause of ischemic stroke and transient ischemic attack.
- Symptomatic CCTO carries a high risk of recurrent stroke, even with optimal medical management.
- Previous surgical interventions have not improved patient outcomes.
Purpose of the Study:
- To review advancements in endovascular recanalization for CCTO.
- To identify key steps for standardizing endovascular procedures for CCTO.
- To assess the potential of endovascular treatment for symptomatic CCTO.
Main Methods:
- Review of recent literature on endovascular CCTO treatment.
- Analysis of meta-analysis data on procedural success and complications.
- Discussion of challenges and future directions for endovascular CCTO therapy.
Main Results:
- Endovascular treatment is a feasible strategy for CCTO to restore cerebral perfusion.
- Recent meta-analyses indicate high procedural success rates with acceptable complication rates.
- Evidence from randomized controlled trials is currently lacking.
Conclusions:
- Endovascular recanalization is a developing strategy for symptomatic CCTO.
- Standardization of techniques is crucial for future clinical trials.
- Further research is needed to establish endovascular treatment efficacy in randomized trials.
Abstract:
Chronic carotid total occlusion (CCTO) is a known cause of ischemic stroke and transient ischemic attack. Symptomatic CCTO is associated with up to 30% risk of recurrent ischemic stroke, despite optimal medical treatment. Notably, a randomized controlled trial reported that previous surgical management did not improve the overall prognosis of these patients. Endovascular treatment of CCTO has been proposed as a feasible strategy to re-establish cerebral perfusion in symptomatic patients. However, its use is controversial and not supported by evidence from randomized clinical trials. Recently, a meta-analysis reported a reasonably high procedural success without an excess periprocedural complication rate, but several steps are needed before the procedure is mature enough to be tested in randomized controlled trials. This review highlights the developments in the endovascular recanalization of CCTO and emphasizes key steps towards standardizing the procedure.
More Related Videos
13:18Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
Published on: November 22, 2024
09:48Quantification of Neurovascular Protection Following Repetitive Hypoxic Preconditioning and Transient Middle Cerebral Artery Occlusion in Mice
Published on: May 4, 2015