Abstract WMP42: Revascularization of Symptomatic Chronically Occluded Internal Carotid: A Meta-Analysis

Abstract

Objective: The overall annual risk of stroke from a chronically occluded internal carotid artery (COICA) is approximately 5%-7%, despite maximal medical management. In addition, patients with COICA have neurocognitive impairment. This emphasizes the importance of identifying candidates who will have more favorable outcomes with intervention compared to medical management. There has not been a comprehensive analysis of existing literature related to treatment of COICA to compare with the natural history of the disease. We conducted a meta-analysis of all studies reporting on patients with COICA receiving endovascular intervention. Methods: Studies that involve patients with COICA that underwent recanalization using endovascular interventions or hybrid (combination) technique were included if they reported on: morbidity, mortality, successful revascularization rate and duration of occlusion. Results: Sixteen studies on 333 patients with COICA were included. The mean age of the patient sample was 67.2 years old (SD = 9.3). The mean duration of occlusion was 7.4 months (SD = 9.4). 70% of patients had a successful recanalization. 3.9% of patients experienced major complications and 2.4% experienced minor complications following the procedure. Among the most common complications were severe periprocedural hypotension/bradycardia (5.4%), hemorrhagic complications (2.4%), and ischemic strokes (2.1%). Depending on the type of occlusion , the total complication rate was 6.25% in favorable types of COICA compared to 31.25% (5/16) in unfavorable ones, with a successful rate of recanalization of 100% in favorable types compared to 37.5%. Neurocognitive outcomes improved after successful recanalization in all cases. Conclusion: This meta-analysis shows that the complication rate for intervention in some cohort was less then the natural history of the disease. It is thus important to identify the favorable types of COICA for intervention. Furthermore, the definition of symptomatic COICA did not include the neurocognitive impairment in this population, which seems to respond to recanalization, arguing thus in favor of intervention.