Endovascular recanalization for symptomatic chronic carotid artery occlusion under local anesthesia: a single-center...

Endovascular recanalization has gained increasing application in the treatment of patients with chronic carotid artery occlusion (CCAO). Despite its common use in the endovascular treatment of CCAO, it is unclear whether local anesthesia is associated with low peri-procedural complications. This study aimed to investigate the safety and efficacy of endovascular recanalization under local anesthesia for patients with symptomatic CCAO.

Consecutive patients with symptomatic CCAO who underwent endovascular recanalization attempts under local anesthesia were retrospectively enrolled in this study. The recanalization attempts were discontinued if the patient reported intolerance. The recanalization success rate and peri-procedural complications were recorded. The underlying reasons for recanalization failure were investigated. A meta-analysis of the recanalization success and peri-procedural complication rates of the CCAO patients who underwent recanalization under local anesthesia was also conducted.

In total, 69 patients were enrolled in the study. The recanalization success and peri-procedural complication rates were 68.1% and 2.9%, respectively. No iatrogenic vascular complications occurred. Recanalization failed in 22 patients, of whom, the cavernous segment could not be navigated in 14 patients, and the extracranial segment could not be transversed in eight patients. A total of seven studies, including this study, were included in the meta-analysis. Overall, the recanalization success rate was 66.2% [95% confidence interval (CI): 61.2% to 70.1%, I²=41%]. The peri-procedural and vascular complication rates were 5.5% (95% CI: 4.4% to 8.2%, I²=36%) and 4.9% (95% CI: 2.8% to 8.0%, I²=0%), respectively.

Endovascular recanalization for CCAO under local anesthesia was feasible and was associated with a low rate of peri-procedural complications.