Hybrid Surgery for symptomatic chronic internal carotid artery occlusion: a single-center experience
Jinbiao Yao1,2, Bingjie Zheng1, Qi Sun1
1Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
Insights
Hybrid surgery shows promise for symptomatic chronic internal carotid artery occlusion (ICAO), achieving high revascularization rates. However, careful patient selection is crucial due to potential complications in treating this stroke risk.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Symptomatic chronic internal carotid artery occlusion (ICAO) presents a significant stroke risk despite medical management.
- Evaluating novel surgical approaches is critical for improving patient outcomes.
Purpose of the Study:
- To assess the effectiveness and safety of hybrid surgery for symptomatic chronic ICAO.
- To determine revascularization rates, complication incidence, and clinical outcomes.
Main Methods:
- Retrospective case series of 27 patients with symptomatic chronic ICAO undergoing hybrid surgery.
- Data collection included baseline characteristics, lesion details, revascularization success, complications, and follow-up.
- Vascular patency and clinical outcomes were assessed via imaging and neurological examination.
Main Results:
- Hybrid surgery achieved 100% technical success in revascularization.
- The perioperative complication rate was 14.8% (4/27 patients).
- At a median 6-month follow-up, 90.5% vascular patency was confirmed, with no new strokes in the target territory.
Conclusions:
- Hybrid surgery is a viable option for symptomatic chronic ICAO, offering high revascularization rates.
- Treatment-related complications necessitate careful patient selection and adherence to technical guidelines.
- This approach may reduce recurrent stroke risk in carefully selected high-risk patients.
Background:
Patients with symptomatic chronic internal carotid artery occlusion (ICAO) face a high risk of recurrent stroke despite receiving aggressive medical therapy. This study aimed to evaluate the effectiveness and safety of hybrid surgery in treating symptomatic chronic ICAO.
Methods:
This retrospective case series was conducted at a single center. From January 2019 to December 2022, patients with symptomatic chronic ICAO who underwent hybrid surgery were included. We collected baseline data, lesion characteristics, revascularization rates, perioperative complications, and follow-up outcomes.
Results:
The study enrolled 27 patients, comprising 22 males and 5 females, with symptomatic chronic ICAO. The hybrid surgery achieved a technical success rate of 100% for revascularization (n = 27), with a perioperative complication rate of 14.8% (n = 4). Following a median follow-up of 6.0 months (IQR, 4-10), 21 patients underwent a DSA or CT angiography reexamination, confirming a vascular patency rate of 90.5% (n = 19). One patient required surgery for severe in-stent restenosis, and another experienced asymptomatic occlusion. Clinical follow-ups were conducted for all 26 patients; no new strokes were reported in the qualifying artery territory, with 13 patients scoring 0, 12 scoring 1, and 1 scoring 2 on the mRS.
Conclusion:
Although hybrid surgery represent a promising option for treating chronic ICAO, they are also associated with a relatively high incidence of treatment-related complications. The application of composite surgery should be based on standardized technical guidelines and the careful selection of patients who are genuinely at high risk for recurrent strokes.
