Endovascular Recanalization for Nonacute Carotid Artery Occlusion: A Nationwide Registry-Based Cohort Study

The management of nonacute symptomatic internal carotid artery occlusion remains unsatisfactory. Endovascular recanalization has been reported to be feasible but associated with a noteworthy risk of postprocedural complications in patients with symptomatic internal carotid artery occlusion. The present study aimed to investigate whether successful recanalization exerts clinical benefits over procedural risks.

We analyzed consecutive patients who underwent endovascular treatment of nonacute symptomatic internal carotid artery occlusion in a nationwide prospective registry. The primary outcome was the ipsilateral ischemic stroke recurrence. Other outcomes of interest included all strokes and death during follow-up, and 30-day symptomatic intracranial hemorrhage, and all strokes after intervention.

The final analysis included 511 patients. Endovascular revascularization was successful in 300 patients (58.7%) but failed in 211 patients (41.3%). Patients with successful recanalization had less time from the last ischemic event to the endovascular treatment as compared with patients with failed recanalization (median [interquartile range] days, 18 [12-33] versus 22 [14-50]; P=0.003). Successful recanalization was associated with a higher rate of symptomatic intracranial hemorrhage within 30 days after intervention (odds ratio [OR], 7.99 [95% CI, 1.02-62.39]; P=0.047). Thirty-day all strokes (OR, 1.91 [95% CI, 0.83-4.40]; P=0.128) and ischemic stroke (OR, 0.90 [95% CI, 0.33-2.46]; P=0.839) did not differ significantly. During a median follow-up of 37 months, patients with successful recanalization demonstrated a reduced risk of ipsilateral ischemic stroke (adjusted hazard ratio, 0.28 [95% CI, 0.13-0.59]; P<0.001). The 5-year risk of all strokes and death was likewise lower in patients with successful recanalization (restricted mean survival time difference, 3.77 months [95% CI, 0.16-7.38]; P=0.041).

Despite an increase in the 30-day symptomatic intracranial hemorrhage, successful recanalization was associated with reduced long-term risk of ipsilateral ischemic stroke in patients with symptomatic internal carotid artery occlusion.