Improved Hybrid Surgery for Chronic Carotid Artery Occlusion: A Technical Note

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Interventions

Background:

• Optimal hybrid surgical techniques for chronic total occlusion (CTO) are not well-defined.
• CTO interventions carry risks like embolism and dissection.

Purpose of the Study:

• To report an improved hybrid surgical strategy for carotid artery CTO.
• To evaluate a dual arterial sheath placement technique (carotid and femoral) for enhanced procedural success and reduced risks.

Main Methods:

• A collaborative hybrid procedure involving vascular surgeons and neurointerventionalists.
• Carotid endarterectomy followed by neurointerventional management of the distal lesion via a carotid sheath (balloon dilatation or thrombus aspiration).
• Final carotid stenting via a femoral artery sheath to ensure lumen patency.

Main Results:

• Two male patients with right internal carotid artery occlusion underwent the procedure.
• Successful management of distal occlusion using thrombus aspiration or balloon angioplasty.
• Carotid artery patency was restored in both patients post-stenting without complications.

Conclusions:

• The improved hybrid technique is feasible and safe for treating chronic carotid occlusion.
• Dual-sheath intervention combined with endarterectomy shows promise, warranting further investigation in larger studies.